Management of Menstrual Bleeding During Treatment for Nongynecologic Malignancy [88

Abstract

INTRODUCTION: More than 800,000 new cases of cancer are diagnosed in women each year. Standard treatments can cause severe thrombocytopenia that may result in heavy menstrual bleeding. The objective of this study was to assess current practices for menstrual suppression and identify the frequency of acute vaginal bleeding that requires gynecologic consultation, medical or surgical intervention, or blood transfusion. METHODS: This was a retrospective case–control study of female patients aged 10–54 years with nongynecologic malignancies treated at Northwestern Memorial Hospital between 2008 and 2013. Women with a documented episode of vaginal bleeding were matched by age, cancer type, and year of diagnosis with women who did not have a bleeding episode. χ2 tests estimated differences between groups. RESULTS: Seventy-three women with an episode of vaginal bleeding were identified and matched with 73 women in a control group. Mean age was 49.4 years. The most common diagnoses were breast (80.8%) and thyroid cancer (12.3%). Of women with bleeding, 68 required gynecologic consultation (93.2%) and 36 required intervention (49.3%). The most common interventions were dilatation and curettage (26%), intrauterine device (IUD) (9.6%), hysterectomy (6.8%), oral contraceptive pills (5.5%), and oral progestins (2.7%). One patient received a transfusion. Few patients received menstrual suppressive therapy, but this was more common among women who bled (13.7% compared with 2.7%; P=.02). Six women used oral contraceptive pills, five an IUD, and two a gonadotropin-releasing hormone agonist for suppression. CONCLUSION: Among women with nongynecologic malignancies, treatment-associated thrombocytopenia can result in significant vaginal bleeding, requiring medical or surgical intervention. Optimal preventative strategies should be explored to avoid these complications.