Endometritis may cause spotting in women after being prescribed oral
contraceptives
P.-A. Märdh (1), B. Sikström (2), M. Rörbeck (2), L. Smeds (2)
Department of Obstetrics and Gynecology, Lund University, Lund (1) and
Carolina Clinic, Uppsala (2), Sweden
Introduction: Women starting using oral contraceptives may experience
irregular bleeding, i.e. spotting, which is generally contributed to hormonal
imbalance.
Aims and Methods: To investigate the presence of chlamydial infection
and vaginal flora changes in women taking combined oral contraceptives with and
without spotting, we investigated ninety-two women, aged 18.20 years, prescribed
low-dose oral contraceptives, of whom 45 bad spotting and 47 bad no such an
irregularity. Endometrial aspirates were made from the women with spotting,
which were cultured on cycloheximide-treated McCoy cells. Cervical samples of
all women were tested for Chlamydia trachomatis and Neisseria gonorrhoeae. The
vaginal samples were studied for bacterial vaginosis and other flora changes, i.e.
cages with lack of dominance of lactobacilli in the vagina. Women with spotting
were given 300 mg of lymecycline twice daily for 10 days and 400 mg of
metronidazole three times daily for 7 days.
Results: A chlamydial infection occurred in 22.2% of those with
spotting and in 10.6% without spotting (p<0.05). The corresponding percentages for flora changes were 40.0% and 12.8%, respectively (p<0.01). BV was found in 53.3% in those with bleeding irregularities and in 23.4% in the comparison group (p<0.01). No bad gonorrhoea. In three women, only the endometrial aspirate were culture-positive for C.trachomatis The mean number of episodes of spotting during the next pill chart, decreased from 5.3 to 1.7 in those given antibiotic therapy and from 7.3 to 3.9 in those not given such drugs.
Conclusion: Women using low-dose combined oral contraceptives
developing spotting should be carefully examined for infections and vaginal
flora changes before prescribed a new brand of pill or a pill with higher
hormonal content.
