NEW ORLEANS -- Decidual cast expulsion may occur in young patients using depot medroxyprogesterone acetate, Stephen M.
The findings in each case were consistent with decidual cast expulsion, and all patients had a negative result on a pregnancy test.
We probably all feel comfortable with the fact that decidual cast formation is just an intense reaction and variant of menstruation, but because it is rare and unpredictable, we don't really have a great idea of what elements are needed in order to form a decidual cast and pass it," he said.
In theory, however, decidual cast formation can be expected when prolonged endometrial proliferation precedes progesterone exposure, leading to a thicker endometrial layer.
Although these cases involved varying clinical scenarios, it can be argued that similar hormonal events may have led to the decidual cast formation and passage, he said.
For this reason, as well as to fully inform patients about the potential effects of DMPA and to promote treatment compliance, patient counseling should include discussion of decidual cast expulsion as a rare side effect associated with the drug.
Although decidual casts are typically associated with ectopic pregnancy and can be confused with spontaneous abortion, Dr.
DMPA treatment in these patients would then have resulted in a high level of progesterone exposure followed by a gradual decline in progesterone levels that might have led to the decidual casts, he explained.
In most of these cases, the decidual casts were, understandably, very frightening for the patient and/or parent, he said.