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Depot Medroxyprogesterone Acetate: A Risk Factor for Cervical Stenosis After Loop Electrosurgical Excisional Procedure Management of Cervical Intraepithelial Neoplasia?

Martirosian, Tovia Elizabeth MD1; Smith, Steven Christopher MD, PhD2; Baras, Alexander Spyridon PhD3; Darracott, Mixon M. MD1

Journal of Lower Genital Tract Disease: January 2010 - Volume 14 - Issue 1 - pp 37-42
doi: 10.1097/LGT.0b013e3181b0f73f
Original Articles
Spanish Translation

Objectives: In our anecdotal experience and sporadically in the literature, gynecologists have observed a connection between patient's use of depot medroxyprogesterone acetate (DMPA) and increased occurrence of cervical stenosis during follow-up after loop electrosurgical excisional procedure (LEEP). We decided to formally examine this association in our clinic population.

Materials and Methods: We performed a chart review, enrolling 257 patients and tabulating data on demography, use of hormonal contraceptives, characteristics of the LEEP, and presence or absence of cervical stenosis at 1- and 6-month follow-up evaluations. Univariate tests of association between the independent variables and the dependent variable of cervical stenosis were examined via the χ2 and Student t tests for discrete and continuous variables, respectively. To characterize the relative importance of independent variables significantly associated with cervical stenosis, logistic regression was performed.

Results: Of the 257 charts reviewed, 127 patients (49.4%) completed 1 and 6 months after LEEP follow-up appointments, providing adequate data for analysis. In this population, we observed 25 cases of cervical stenosis, or an overall rate of 19.7%. Of patients using DMPA at the time of LEEP or during the follow-up period, 9 (41.0%) of 22 developed stenosis, whereas of those who did not use DMPA, 16 (15.2%) of 105 developed stenosis, indicating a significant difference (odds ratio = 3.85, 95% CI = 1.41-10.50).

Conclusions: In our clinic population, use of DMPA was associated with higher rates of development of cervical stenosis, calling for larger studies of the association of DMPA in this LEEP complication.

In our case series, patient's use of depot medroxyprogesterone acetate was associated with increased rates of development of cervical stenosis during follow-up after loop electrosurgical excisional procedure.

Departments of 1Obstetrics and Gynecology, 2Urology, and 3Pathology, UVA Health System, Charlottesville, VA

Reprint requests to: Tovia Elizabeth Martirosian, MD, Department of Obstetrics and Gynecology, PO Box 800712, UVA Health System, Charlottesville, VA 22908. E-mail: tem2p@virginia.edu

This study was supported by the National Institutes of Health Cancer Training Grant CA009109 to S.C.S.

©2010The American Society for Colposcopy and Cervical Pathology