Abnormal uterine bleeding induced by glucocorticoid treatment for pemphigus

Abstract

Glucocorticoids are the first-line treatment option for pemphigus. Moreover, abnormal uterine bleeding (AUB) is a rarely reported side effect of glucocorticoid treatment that usually manifests as abnormal and excessive endometrial bleeding; in fact, AUB can be induced by the systemic or topical application of glucocorticoids. In the present report, we describe the cases of 3 patients with pemphigus who developed AUB following glucocorticoid administration. It is important to note that the administration mode of glucocorticoids, and the onset time and duration of AUB differed among these patients. Thus, we propose the following treatment algorithm for AUB following glucocorticoid administration: 1. perform a gynecological and physical examination to exclude organic diseases. 2. continue glucocorticoid treatment. 3. if AUB persists, change the mode of administration of glucocorticoids. 4. if AUB still persists, despite these measures, completely withdraw treatment with glucocorticoids and use non-glucocorticoid treatments.

Role of Prednisolone in Platelet Activation by Inhibiting TxA2 Generation through the Regulation of cPLA2 Phosphorylation

“…High glucocorticoids have been shown to be effective in combination with first-line medication for some bleeding disorders because of their coagulation function [ 27 ]. It has also been demonstrated that in a majority of bleeding disorders, it is difficult to control the use of glucocorticoids as it may also lead to hypercoagulability such as in venous thromboembolism [ 58 ]. Furthermore, using glucocorticoids has been linked to the development of a number of metabolic disorders [ 59 ].…”

“…Furthermore, using glucocorticoids has been linked to the development of a number of metabolic disorders [ 59 ]. In contrast, glucocorticoids have also been known to cause bleeding disorders in the uterus and gastrointestinal tract [ 58 , 60 ]. Our study has demonstrated that prednisolone inhibits platelet activity, pointing to its potential role in hypo-coagulation and contradicting the prevalent notion that glucocorticoids promote coagulation.…”