Trial of Use of Injectable Progestin (DMPA) Injection and High Dose Oral Progestin (MPA) Tablets in Outpatient Treatment of Acute Excessive Vaginal Bleeding.

Excessive vaginal bleeding is a frequent problem for reproductive age women and accounts for
many office and emergency room visits. This bleeding is caused by cancer, endocrinologic
problems (such as thyroid dysfunction), liver failure, benign tumors of the uterus
(fibroids), and cervix (polyps), as well as hormone imbalances, such as anovulatory cycling.

Even though excessive vaginal bleeding is very common, there has been very little research
into ways to manage it. For non-pregnant women who have stable vital signs and are not
hemorrhaging or experiencing severe anemia, outpatient therapy is generally attempted.
Textbooks recommend treatment with high dose oral contraceptives pills (one tablet orally 2
times a day for 5 days). Recently, Munroe et al published a small study using high doses of
oral progestin (MPA 20mg 3 times daily for 7 days then one daily for 21 days). Using this,
the median time to bleeding cessation was 3 days. Munro reported having difficulty
enrolling adequate numbers of patients to achieve the statistical significance.

The investigators propose a pilot project to study clinical responses to a new hormonal
therapy the blends the high dose oral therapy with the longer acting injectable progestin.
The pilot clinical trial is designed to study 50 women who are bleeding and whose treatment
is amenable to outpatient therapy. Routine care will be provided to each of the women
before she is approached for study enrollment.

This study, therefore, is designed to provide short term proven therapy of 20 mg MPA tablets
3 times a day for 3 days combined with the injectable progestin (DMPA) that lasts for 3
months.

Patients will be called within 24 hours and 48 hours following their first study visit to
ascertain their bleeding status and their use of medication, as well as any significant side
effects they may be experiencing. Patients will be asked to return to the clinic on day 3
for a repeat hemoglobin and interval history. Those women who are still having any bleeding
on day 3 will be contacted on day 5.

The primary outcome measures of the part of the study will be the time elapsed to slowing
acute bleeding as well as compliance with study medications. The patient's time to complete
cessation of bleeding and percent of women having complete bleeding cessation will also be
calculated. Results of the biopsies done before randomization will also be evaluated to see
if they had any influence on study outcomes. From the degree of responses seen in this
pilot study, a larger clinical trial may be designed.