Abstract
To evaluate the efficacy of gonadotropin-releasing hormone agonist (GnRHa) in women with abnormal uterine bleeding (AUB) on anticoagulant therapy. Prospective observational case series (Canadian Task Force Classification II-3) at University-affiliated teaching hospital. From January 2002 through December 2019, three premenopausal women on warfarin therapy were identified from our clinical practice. After clinical assessment, including Papanicolaou smear, endometrial biopsy, and pelvic sonography, a GnRHa was used to treat their AUB. Two women were receiving warfarin therapy (5–7 mg/day) for previous venous thromboembolism and one for mechanical heart valve replacement associated with Marfan’s syndrome. All patients had additional comorbid conditions and were at high risk for traditional medical or surgical therapies. After treatment with GnRHa, all women reported menstrual reduction at 3 months and remained amenorrheic for 2 to 11 years, two of whom reached menopause. In properly assessed and selected premenopausal women with AUB receiving anticoagulant therapy and at high risk for traditional therapies, long-term GnRHa was an effective treatment in 3 patients.
Highlights
Abnormal uterine bleeding (AUB) is any departure from a normal menstruation pattern
A 40-year-old woman, G3P2, body mass index (BMI) 24 kg/m2, presented with abnormal uterine bleeding (AUB). She had been diagnosed with systemic lupus erythematosus (SLE) and carrier of lupus anticoagulant with history of two episodes of deep venous thrombosis (DVT)
The anticoagulation therapy was a contributor to her heavy vaginal bleeding and after discussing treatment options, she underwent endometrial ablation using a hot liquid thermal balloon (Thermablate, Idoman Canada, Toronto, Ontario)
Summary
Abnormal uterine bleeding (AUB) is any departure from a normal menstruation pattern. AUB is experienced by approximately 20% to 30% of premenopausal women [2] and is a common debilitating condition that results in reduced hemoglobin, it adversely affects quality of life, and is associated with significant use of health care resources [3]. Gynecologists managing women presenting with AUB may be faced with medical and/or anatomical conditions that, in conjunction with factors such as age, hormonal, metabolic, and body mass index (BMI), may contribute to AUB. Among these conditions are congenital or iatrogenic bleeding disorders, cardiovascular conditions requiring prostheses, thromboembolic events requiring acute thrombolysis and/ or long term thromboprophylaxis and cerebrovascular accidents. Traditional therapies for AUB, under these circumstances, may be ineffective, refused, contraindicated, difficult or risky to administer
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