Frequent Use of Premenopausal Progestin in Women With Prior Preeclampsia

Women with a history of preeclamptic pregnancy are predisposed to later occlusive vascular diseases.

We compared the use of cyclic progestins or levonorgestrel-releasing intrauterine device (LNG-IUD) for treatment of menstrual cycle abnormalities between premenopausal women with and without a prior preeclamptic pregnancy.

Register-based cohort study during 1994 to 2019 of oral progestin or LNG-IUD in Finnish women with (n = 31 688) and without (n = 91 726) prior preeclampsia in 1969 to 1993. Cyclic progestin or LNG-IUD use and its association with future use of menopausal hormone therapy (MHT).

Women with prior preeclampsia had used cyclic progestins more often (23.5% vs 9.1%; P < .001) and initiated the use at younger ages (41.8 years, SD 6.3 vs 45.9 years, 3.1; P < .001) than control women. Also, LNG-IUD was inserted more frequently (P < .001) in women with prior preeclampsia (9.3%) than in controls (4.7%). Cyclic progestin or LNG-IUD use was accompanied by significant 37% to 90% elevations in future MHT use.

Increased use of cyclic progestins and LNG-IUD in premenopausal women with a history of preeclamptic pregnancy can be seen as indirect evidence of earlier onset of ovulatory dysfunction. This may contribute to the elevated risk of endometrial cancer in these women. Our findings may indicate an additional late sequela of preeclamptic pregnancy.