Therapeutic Amenorrhea in Patients at Risk for Thrombocytopenia

Abstract

To examine the need for and evaluate the method of menses suppression in women at risk for thrombocytopenia. A systematic review of the published literature in MEDLINE using the search terms thrombocytopenia, menorrhagia, therapeutic amenorrhea, progestin intrauterine device, combination oral contraceptive-extended and cyclic, gonadotropin releasing hormone agonist, danazol, and progestins. There are an increased number of reproductive age women at risk for thrombocytopenia who would benefit from menses suppression. A number of effective medical regimens are available. In patients who fail medical therapy, endometrial ablation appears to be effective in women with thrombocytopenia. As a result of the increased number of women at risk for thrombocytopenia, there is a need for therapeutic amenorrhea. The type of regimen selected depends upon the patients need for contraception and the ability to tolerate estrogen-containing medications. For women who fail medical therapy, there are surgical options, which are associated with less morbidity than hysterectomy.Dysfunctional uterine bleeding is one of the most common complaints in the field of obstetrics and gynecology (1). The incidence of menorrhagia and abnormal uterine bleeding is about 5% in the general population (2), and a cause is identified in only 50% of affected individuals (3). Patients with thrombocytopenia are at particular risk for gynecologic bleeding complications. Almost half of patients with thrombocytopenia caused by current disease or treatment also have menorrhagia (4). Some studies have indicated that the incidence of women presenting to a physician complaining of menorrhagia who have a Reprint requests to: Alicia Armstrong, MD, National Institutes of Health, Reproductive Biology and Medicine Branch, Rm. 1E-3140 CRC Bldg. 10, 10 Center Drive, Besthesda, MD 20892. armstroa@mail.nih.gov. The authors have disclosed that they have no financial relation ships with or interests in any commercial companies pertaining to this educational activity.The authors have disclosed that GnRH agonists (Lupron) has not been approved by the U.S. Food and Drug Administration for use in the treatment of menses supression in patients with thrombacytompenia. Please consult product labeling for the approved usage of this drug.Lippincott Continuing Medical Education Institute, Inc. has identified and resolved all faculty conflicts of interest regarding this educational activity. HHS Public Access Author ManuscriptAuthor Manuscript Author ManuscriptAuthor Manuscript coexisting inherited coagulation disorder is 17% to 20% (5,6). Uterine bleeding in this population can cause significant morbidity and require inpatient treatment and transfusion.Thrombocytopenia in reproductive age women can result from a number of causes: a decrease in platelet production, an increase in the destruction of platelets, and iatrogenic effects of medications. Patients with leukemia, myelodysplastic syndrome, aplastic anemia, liver failure, or hereditary syndromes may have thrombocytopen...

Safety, efficacy and patient satisfaction with continuous daily administration of levonorgestrel/ethinylestradiol oral contraceptives

“…In addition, extended pill use (with or without interruption) has also been advocated as a maintenance treatment for endometriosis-associated pelvic pain in women not wishing to become pregnant,67,68 to avoid menstruation-associated symptoms, such as migraine headache69 and premenstrual syndrome 65. In addition, Martin-Johnston et al70 found that there is an increased number of reproductive age women at risk for thrombocytopenia and, they too, would benefit from menses suppression.…”

Hormone Use for Therapeutic Amenorrhea and Contraception During Hematopoietic Cell Transplantation

“…The choice of agent depends on the time to transplant, patient’s need for contraception, desire for future fertility, medical history, as well as whether emergent intervention is required in the setting of acute uterine bleeding. (6)…”

“…No studies, albeit limited, suggest an increased likelihood of febrile morbidity with progestin-containing IUD use in immunosuppressed women. (6) In the absence of data regarding safety and efficacy, if a patient is already amenorrheic with a progestin-containing IUD or implant, its continued use while undergoing hematopoietic cell transplantation may be considered. (14) The patient is then counseled that in the event of neutropenic fever arising during or after transplant, a request to remove the progestin-containing IUD may occur.…”

Management of Menorrhagia Associated with Chemotherapy‐Induced Thrombocytopenia in Women with Hematologic Malignancy

“…Thrombocytopenia may be a result of a malignancy or may be caused by myelosuppressive chemotherapy, radiation therapy, platelet consumption, coagulopathies, or other drugs. [28][29][30]…”