Prospective Case-Control Study of Abnormal Bleeding after Outpatient Corticosteroid Injection

Objective: This study is aimed at evaluating the incidence of bleeding among women having outpatient corticosteroid injection compared to matched controls, using mailed surveys and electronic health records. Study Design: Prospective survey study of women receiving outpatient corticosteroid injection for joint or back pain (cases) compared to women matched for visit, diagnosis of joint/back pain, and age, who did not receive an injection (controls). A survey was mailed 45 days following outpatient visit, inquiring about menstrual history, abnormal bleeding, and potential risk factors. The proportion of women reporting abnormal bleeding was compared between cases and controls, and stratified by menopausal status. Results: One thousand and sixty two surveys were mailed to 531 identified cases/control pairs, and 40% response was seen from each group. Of 379 analyzable responders, 135 (36%) were premenopausal and 244 (64%) postmenopausal. Postmenopausal women who had a corticosteroid injection were more likely to report recent abnormal bleeding compared to controls (17 vs. 7%, p = 0.02), whereas rates were similar among premenopausal women 50 vs. 43%, p = 0.39). When logistic regression was performed, injection was associated with bleeding among postmenopausal women, independent of body mass index and hormone use. Conclusions: Corticosteroid injection is associated with increased abnormal vaginal bleeding among postmenopausal women. (C) 2016 S. Karger AG, Basel