Progestin-only use for patients with abnormal uterine bleeding (aub) with the risk of venous thromboembolism (vte): case series and literature review

Background: Risk of venous thromboembolism (VTE) has been the main concern for all the hormonal contraceptives used for AUB. Hormone treatment with estrogen and progesterone has shown risk of developing VTE among the patients. Progestin only is being used by various clinicians to avoid the complication of VTE. The present case series and the literature review have focused on progestin-only use (oral, IUD, injectable, implant) to manage abnormal uterine bleeding specially among high risk patients group.
Material and methods: It was a case series study in which 4 cases of AUB with risk of VTE were treated with progestin only hormone and were followed up for venous thromboembolism .A literature review on the tretment of abnormal uterine bleeding patients with risk of VTE by progestin only hormone was done.The outcome of the progetin only hormone treatment on the case series was compared by the literature review.
Results: Among the four cases with Abnormal Uterine Bleeding (AUB),the first and the fourth cases were treated with oral Primolut N (Norethisterone) and the patient ended up with massive right lower limb DVT in the third case and pulmonary embolism and deep vein thrombosis in the leg in the fourth case. The second case in her young age (29 years) admitted for AUB with h/o SLE and positive anti-phospholipid antibodies was treated with Mirena IUD and the patient improved without any sign of DVT. The third post-menopausal obese case with hypertension, Type 2 DM and endometrial hyperplasia with atypical cells was teated with Megestrol acetate at a dose of 160mg/orally /day and the patient improved after 2 weeks of treatment without any thromboembolic event.
Conclusion: A progestin-only oral formulation used in therapeutic doses in the women with abnormal uterine bleeding was not found free from risk of developing VTE. However the literature reviews suggest that its use in contraception dose did not appear to increase the risk of venous thromboembolic disease. Mirena IUD appeared to be better option for women suffering from abnormal uterine bleeding with risk factors of venous thromboembolism. This case series and the review demonstrated the complex situation for the clinician for treating women with progestin for abnormal uterine bleeding. Each case need to be assessed on its own merit and the health care professional must develop the suitable treatment plan for the women at high risk of VTE