Management of Menorrhagia Associated With Chemotherapy-Induced Thrombocytopenia in Women With Hematologic Malignancy

Jill S. Bates, Pharm.D., M.S.; Larry W. Buie, Pharm.D.; C. Brock Woodis, Pharm.D.


Pharmacotherapy. 2011;31(11):1092-1110. 

In This Article


Menorrhagia is a common complication of myelosuppressive chemotherapy in premenopausal women that can cause significant morbidity. Prevention of the menorrhagia remains a steadfast goal for these women. Data suggest that leuprolide is effective in attenuation of vaginal bleeding during periods of thrombocytopenia without significant adverse effects. More robust, randomized, placebo-controlled, clinical trials in this patient population are warranted to evaluate optimal dosing strategy, route of administration, and timing of leuprolide therapy for this indication. In women receiving myelosuppressive chemotherapy who experience menorrhagia despite preventive efforts, tranexamic acid appears to be an effective agent. For those who are nonresponsive to antifibrinolytic therapy, a short course of intravenous conjugated estrogens is indicated to stop bleeding. Once bleeding is controlled, a maintenance regimen to prevent further episodes should be used. Further clinical trials are warranted to evaluate the safety and efficacy of tranexamic acid in the cancer population receiving myelosuppressive chemotherapy.


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