Prevention of severe menorrhagia in oncology patients with treatment‐induced thrombocytopenia by luteinizing hormone‐releasing hormone agonist and depo‐medroxyprogesterone acetate

Abstract

BACKGROUNDMenorrhagia is a serious complication in young female oncology patients who suffer from severe thrombocytopenia during myelosuppressive treatment. To the authors' knowledge, little is known regarding the incidence of this complication or the effectiveness of possible therapies for its prevention.METHODSIn this retrospective clinical study, after a thorough gynecologic evaluation, young female oncology patients with regular menstrual cycles undergoing myelosuppressive treatments received either depo‐medroxyprogesterone acetate (DMPA), or D‐tryptophan‐6‐luteinizing hormone‐releasing hormone depot treatment (gonadotropin‐releasing hormone agonist [GnRH‐a]), or no treatment before the administration of myelosuppresive chemotherapy. Only patients who later developed severe thrombocytopenia (<25,000 platelets per μL) were included in the study. Daily blood counts, menorrhagia, nonvaginal bleeding episodes, and the need for blood products, gynecologic consultations, and other medical interventions were determined.RESULTSOf 101 women with cancer who met the inclusion criteria, 42 patients received DMPA, 39 patients received GnRH‐a, and 20 patients remained untreated. The mean duration (± standard deviation) of severe thrombocytopenia was 24.76 ± 23.6 days. Four patients were not included because of significant gynecologic pathologies. General bleeding from nongynecologic sites was similar for all groups and was not associated with vaginal bleeding. Severe or moderate menorrhagia was documented in none of the 39 women who received GnRH‐a, in 9 patients (21.4%) who received DMPA, and in 9 untreated patients (40%; P = .02). Fewer calls for urgent gynecologic consultations were documented in the GnRH‐a group compared with the untreated group (P < .0001).CONCLUSIONSFemale patients undergoing myelosupressive therapy are at high risk of developing significant menorrhagia during prolonged, severe thrombocytopenia. Pretreatment gynecologic evaluation can detect significant pelvic pathologies. GnRH‐a treatment effectively prevented menorrhagia, whereas DMPA administration was less effective. Cancer 2006. © 2006 American Cancer Society.

How to Preserve Fertility in Young Women Exposed to Chemotherapy? The Role of GnRH Agonist Cotreatment in Addition to Cryopreservation of Embrya, Oocytes, or Ovaries

“…Furthermore, it may decrease thrombocytopenia-associated menorrhagia, as recently described [37]. Moreover, the recent studies of Recchia et al [25,26] and Del Mastro et al [27] supporting this cotreatment in breast cancer have shown that, in premenopausal women with early breast carcinoma, the addition of a GnRH agonist to adjuvant therapy and temporary total estrogen suppression in patients with estrogen receptor-positive disease was well tolerated, protected long-term ovarian function, and appeared to improve the expected clinical outcome [25,26].…”

“…The only significant difference was the rate of POF: Ͻ7% in the GnRH agonist cotreatment group versus Ͼ53% in the control (chemotherapy without the GnRH agonist) group [1, 4, 7, 10, 11, 14, 16 -19]. The relatively advanced age (35,37,40, and 40 years) of four of the five patients in the study group who developed POF (the fifth had oophorectomy for pelvic recurrence) suggests that minimizing follicular loss may be efficient only in young patients whose follicular reserve is above a certain limit. In patients older than 36, this reserve may not be sufficient.…”

Use of intrauterine balloon tamponade in successful conservative management of life threatening menorrhagia in a patient with idiopathic thrombocytopenic purpura and severe anemia

“…Another study evaluated 101 premenopausal women undergoing myelo-suppressive chemotherapy who developed severe thrombocytopenia (platelet counts less than 25,000/ L). 6 This study group was on average older (mean age 29.8 8.8 years) than the previous study. The sample included 20 untreated patients who had a 40% incidence of lifethreatening bleeding requiring intervention.…”

Possible applications analogues of gonadotropin-releasing hormone puberty in girls with cancer

“…Тем не менее на сегод-няшний день специфические факторы, стимулирую-щие выработку тромбоцитов, в широкой клинической практике отсутствуют. Переливание тромбовзвеси яв-ляется ограниченным методом и может быть ассоции-ровано с развитием осложнений [6,7]. У девочек, до-стигших полового созревания, следует помнить о высоком риске развития меноррагий в период тром-боцитопении после миелосупрессивных режимов ХТ.…”

“…Геморрагические осложнения представляют 2-ю по частоте причину смертности у взрослых пациенток с лейкозом и другими онкологическими заболевания-ми, поэтому проблема профилактики гиперменореи высокоактуальна. Важно подчеркнуть, что девочки, достигшие полового созревания, до начала противо-опухолевого лечения должны быть консультированы врачом-гинекологом с целью оценки менструальной функции, данных ультразвукового исследования (УЗИ) органов репродуктивной системы, гормонального ста-туса [7].…”