Albert Einstein College of Medicine, Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, NY 10467, USA.
Pain Med. 2010 May;11(5):713-5. doi: 10.1111/j.1526-4637.2009.00775.x. Epub 2010 Jan 8.
A 47-year-old female was referred for evaluation of chronic lower back pain. A magnetic resonance imaging of her lumbar spine revealed a broad-based disc herniation at L4-L5 with bilateral neural foraminal narrowing. A decision was made to treat her with bilateral L4-5 transforaminal epidural steroid injections. Following moderate pain relief, the procedure was repeated. Several days after each injection, the patient experienced unusually heavy and painful menstrual bleeding. We postulate that the introduction of exogenous corticosteroids directly into the neuraxial space can initiate a negative feedback loop on the hypothalamic-pituitary-ovarian axis. As a result, this may lead to decreased levels of circulating hormones, resulting in episodes of menorrhagia in the premenopausal population.
一位 47 岁女性因慢性下腰痛就诊。她的腰椎磁共振成像显示 L4-L5 处有一个宽基底椎间盘突出，双侧神经孔狭窄。决定对她进行双侧 L4-5 经椎间孔硬膜外类固醇注射治疗。中度疼痛缓解后，再次进行了该程序。每次注射后几天，患者经历了异常严重和疼痛的月经出血。我们推测，外源性皮质类固醇直接注入神经轴可以在下丘脑-垂体-卵巢轴上引发负反馈环。因此，这可能导致循环激素水平下降，导致绝经前人群出现月经过多。
