Abnormal Uterine Bleeding Following Lumbar Epidural Corticosteroid Injections and Facet Medial Branch Blocks in Both Pre‐ and Postmenopausal Women: A Case Series

Background.  Epidural steroid injections (ESIs) are now increasing in popularity with regard to the management of chronic lumbar radiculopathy. While ESIs have been shown to be effective in relieving low back and radicular pain, adverse reactions have also been reported, notably abnormal vaginal bleeding. Objective.  We present a case series of four women, both pre‐ and postmenopausal, with chronic lumbar radiculopathy and corresponding pathology who developed abnormal vaginal bleeding after receiving either ESIs or facet medial branch blocks (MBBs) for pain management. Setting.  University of California, Los Angeles. Patients.  Four women, both pre‐ and postmenopausal. Conclusions.  We discuss the potential effects of corticosteroids on the hypothalamic–pituitary–ovarian axis and highlight our patients' risk factors for abnormal vaginal bleeding, both exogenous and endogenous, as well as focus on the technical approaches to corticosteroid administration utilized in our patients' procedures. We acknowledge that because this is a small case series, further prospective investigation is warranted regarding the above topics. Until then, it may be beneficial to consider whether patients, both pre‐ and postmenopausal, have risk factors for abnormal uterine bleeding prior to undergoing interventional pain management strategies, specifically ESI and MBB, and to inform all women upon consent that abnormal vaginal bleeding is a potential risk following procedures with corticosteroids.