Centchroman use in dysfunctional and abnormal uterine bleeding after D and C

Piyusha Chandrayan, Foram H. Naik, Deepak Desai
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2018 · vol. 7(9) , pp. 3502 · doi:10.18203/2320-1770.ijrcog20183391 · W2887737568
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This study investigated Centchroman's efficacy for dysfunctional and abnormal uterine bleeding, finding it effective for menorrhagia with early proliferative endometrium in DUB patients and safe for fibroids, with breakthrough spotting as the main side effect.

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This interventional study evaluated the efficacy and safety of centchroman, a non-hormonal drug, in treating dysfunctional and abnormal uterine bleeding among 50 patients following dilatation and curettage. The results indicated that while patients with early proliferative endometrium responded well to the medication, those with late proliferative phase or structural causes like fibroids and adenomyosis largely failed to respond and required hysterectomy. Although breakthrough spotting was a common side effect, no major complications were observed, suggesting the drug is relatively safe for specific histological profiles. Relevance to endometriosis: Adenomyosis is listed as one cause of abnormal uterine bleeding included in the study cohort, though the paper's main focus is the pharmacological management of menorrhagia rather than the pathophysiology of adenomyosis itself.

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Abstract

Background: Incidence of DUB is more in the age group of 30-35yr and is about 35%-40%. Medical management (Centchroman) can be the treatment of preference, after excluding any organic pathology in uterus. To evaluate efficacy and side effects of Saheli (Centchroman) in case of dysfunctional uterine bleeding will depend upon the type of endometrium as determined histologically after minor procedure, D&C (Dilatation and Curettage). This drug will be used only in the presence of Proliferative Endometrium on Histopathological Examination.Methods: The study was carried out at Dhiraj Hospital, Piparia. It was an Interventional Study. 50 patients were studied in 6 months of period, 25 each of DUB and AUB. A total of 50 patients were enrolled in this study, who were attending or were admitted in the hospital. Patients who meet the inclusion criteria were included in this study, after taking prior written and informed consent.Results: Most of the patient were in the age group 39-45 years. The common complaint was excessive uterine bleeding, for which they were prescribed Centchroman. Most of the DUB patients were relieved on medication. However, few of them who had poor response to drug went for hysterectomy. It was observed that patients with early proliferative phase on HPE had better response to this drug as compared with late proliferative phase. All the patients with late proliferative phase underwent hysterectomy. Most patient with AUB including Fibroid, Adenomyosis, Endometrial hyperplasia had little or no response went for hysterectomy sooner or later on after therapy in 50% cases. Centchroman is relatively a safe drug. The most common side effect encountered was breakthrough spotting in 15 patients. 4 patients complained of amenorrhoea after 3 months of taking this drug and 1 patient complained of itching and rash over the body. No major complications were noted.Conclusions: Centchroman can be an effective non hormonal drug used for menorrhagia with proliferative endometrium with early changes in patients of DUB. This drug can also be used to control menorrhagia in patients with fibroid. This is also beneficial in patients with menorrhagia with medical illness to avert hysterectomy.
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Background

Incidence of DUB is more in the age group of 30-35yr and is about 35%-40%. Medical management (Centchroman) can be the treatment of preference, after excluding any organic pathology in uterus. To evaluate efficacy and side effects of Saheli (Centchroman) in case of dysfunctional uterine bleeding will depend upon the type of endometrium as determined histologically after minor procedure, D&C (Dilatation and Curettage). This drug will be used only in the presence of Proliferative Endometrium on Histopathological Examination.

Methods

The study was carried out at Dhiraj Hospital, Piparia. It was an Interventional Study. 50 patients were studied in 6 months of period, 25 each of DUB and AUB. A total of 50 patients were enrolled in this study, who were attending or were admitted in the hospital. Patients who meet the inclusion criteria were included in this study, after taking prior written and informed consent.

Results

Most of the patient were in the age group 39-45 years. The common complaint was excessive uterine bleeding, for which they were prescribed Centchroman. Most of the DUB patients were relieved on medication. However, few of them who had poor response to drug went for hysterectomy. It was observed that patients with early proliferative phase on HPE had better response to this drug as compared with late proliferative phase. All the patients with late proliferative phase underwent hysterectomy. Most patient with AUB including Fibroid, Adenomyosis, Endometrial hyperplasia had little or no response went for hysterectomy sooner or later on after therapy in 50% cases. Centchroman is relatively a safe drug. The most common side effect encountered was breakthrough spotting in 15 patients. 4 patients complained of amenorrhoea after 3 months of taking this drug and 1 patient complained of itching and rash over the body. No major complications were noted.

Conclusions

Centchroman can be an effective non hormonal drug used for menorrhagia with proliferative endometrium with early changes in patients of DUB. This drug can also be used to control menorrhagia in patients with fibroid. This is also beneficial in patients with menorrhagia with medical illness to avert hysterectomy. Metrics

References

Hoffman BL, Schorge JO, Bradshaw KaD, Halvorson LM, Schaffer JI, Corton MM. Williams Gynecology. 3rd Ed. Published: McGraw-Hill Education / Medical;2016. Munro MG, Critchley HO, Broder MS, Fraser IS. FIGO classification system (PALM‐COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynecol Obstet. 2011 Apr;113(1):3-13. Lal J. Clinical pharmacokinetics and interaction of centchroman-A mini review. Contraception. 2010 Apr 1;81(4):275-80. Rajswaroob U, Kannan R, Kannnan NS, Tirouaroul T. Effectiveness of centchroman on regression of fibroadenosis and mastalgia. JCDR. 2016 Oct;10(10):PC10. Kriplani A, Kulshrestha V, Agarwal N. The efficacy and safety of ormeloxifene in the management of menorrhagia: a pilot study. J Obstet Gynaecol. 2009;35(4):746-52. Dhananjay BS, Nanda SK. The role of sevista in the management of dysfunctional uterine bleeding. JCDR. 2013 Jan;7(1):132. Makker A, Tandon I, Goel MM, Singh M, Singh MM. Effect of ormeloxifene, a selective estrogen receptor modulator, on biomarkers of endometrial receptivity and pinopode development and its relation to fertility and infertility in Indian subjects. Fertility and sterility. 2009 Jun 1;91(6):2298-307. Srilakshmi B. Ormeloxifene in DUB. Int J Curr Res. 2015;6(12). Borahay MA, Asoglu MR, Mas A, Adam S, Kilic GS, Al-Hendy A. Estrogen receptors and signaling in fibroids: Role in pathobiology and therapeutic implications. Reprod Sci. 2017 Sep;24(9):1235-44. Devi LT, Nimonkar R. Ormeloxifene in the management of dysfunctional uterine bleeding. Int J Reprod Contracept Obstet Gynecol. 2018;7:1885-92.

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