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

Menstrual Cycle

The ovarian hormones estrogen and progesterone, as well as the pituitary hormones folliclestimulating hormone (FSH) and luteinizing hormone (LH), are integral to the menstrual cycle.[14] The menstrual phase, which is caused by progesterone withdrawal, is traditionally known to begin on day 1 of the menstrual cycle and continues for 4–6 days. Estrogen is the predominant circulating sex steroid during the follicular or proliferative phase (usually days 7–14) and is responsible for regeneration of the endometrium. As estradiol levels increase, maturation of the dominant ovarian follicle occurs. Ovulation occurs around day 14 of the menstrual cycle and is triggered by a surge in LH; the secretory or luteal phase (days 15–28) follow.[1,14] Absence of active pregnancy will result in regression of the corpus luteum and decreases in estrogen and progesterone, with menses beginning yet again.[1] Healthy women may have a menstrual cycle that ranges from 21–35 days, with the average being 28 days.[15]

The neuroendocrine effects of gonadotropinreleasing hormone (GnRH) from the hypothalamus is responsible for release of both FSH and LH from the anterior pituitary and is therefore essential to regulation of the menstrual cycle.[15–17] Estrogen and progesterone act by negative feedback on the hypothalamic-pituitary axis to inhibit GnRH.[17] This negative feedback pathway explains why the use of GnRH analogs can lead to a hypoestrogenic state and result in amenorrhea.[18]


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