Mochamad Rasjad Indra, - (1997) Body Mass Index Sebagai Prediktor Terjadinya Perdarahan Uterus Akibat Pemakaian Kontrasepsi Depo-Medroksiprogesteron Asetat : Pendekatan Endokrinologi Hormon Estradiol Dan Progesteron. Disertasi thesis, Universitas Airlangga.

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Abstract

Menstrual bleeding disturbances is the most common reason for discontinuation of DMPA use. However, the mechanism of this bleeding disturbances are not well understood. Simple and reliable management have not yet been investigated. There are some indications that bleeding patterns with low-dose progestogen-only methods are influenced by body weight. The objective of this study is to investigate the relationship between obesity and endometrial bleeding in DMPA user. The study used prospective design with analytical observation. The subjects were divided in to two groups : obese-(BMI ~ 20.16) and non obese - . (BMI < 20.16) group. The independent variables were obesity (BMI), serum estradiol and progesterone concentration. Time series data of estradiol and progesterone were collected by dividing each group into 9 subgroups randomly. The dependent variable was endometrial bleeding that occurred in the first 3 months after injection and collected by using the Bleeding Card. There was a significant difference on estradiol concentration between obese and non obese group (p = 0.028). Estradiol concentration of non obese group showed a greater fluctuation than the obese group {p = 0.0001 ). The difference of estradiol concentration was also found between the bleeding and the amenorrhae group (p = 0.011 ), and the bleeding group showed greater fluctuation of estradiol concentration than amenorrhea group. On the other hand, progesterone concentration were very low ( < 1 ng I ml), and there wasn't significant difference between obese group and non obese group (p = 0.611 ). Logistic Regression Analysis presented highly significant correlation between BMI and endometrial bleeding (r=-0.43; p = 0.001 ). Discriminate value of BMI 21 .63 was found by discriminant analysis. These result suggested that DMPA users tend to suffer from endometrial bleeding if their BMI are less than 21 .63 and amenorrhea if their BMI are more than or equal to 21 .63.

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