Symptomatic Fibroids in Two Patients on Hormone Replacement Therapy with Primary Ovarian Failure Secondary to Prepubertal Gonadotoxic Cancer Treatment

Abstract

We report two childhood cancer patients with primary ovarian failure who underwent exogenous hormone-induced puberty and had symptomatic fibroids while on hormone replacement therapy (HRT). A 26-year-old woman with a history of myelodysplastic syndrome complained of irregular, heavy menstrual bleeding and painful menses; physical examination revealed a 5 cm x 3.5 cm prolapsing fibroid. A 23-year-old woman with a history of acute lymphocytic leukemia complained of irregular and heavy menstrual bleeding; physical examination revealed a 5.5 cm prolapsing fibroid. Patients with primary ovarian failure who are on HRT are capable of developing symptomatic fibroids despite lack of endogenously induced puberty. Diagnosis may be delayed if symptomatic uterine fibroids are not included in the differential diagnosis of abnormal uterine bleeding and pain.