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.

Disclosures

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

In This Article

Pharmacotherapy for Menorrhagia

The antifibrinolytic drug, tranexamic acid, is the only United States Food and Drug Administration (FDA)-approved drug indicated for the treatment of cyclic, heavy menstrual bleeding.[26] However, the levonorgestrel-releasing intrauterine system is indicated and routinely used in women who experience heavy menstrual bleeding and also elect to use an intrauterine device as contraception.[27] Other traditional medical management of menorrhagia includes nonsteroidal antiinflammatory drugs (NSAIDs), danazol, progestins, combined oral contraceptives, and GnRH analogs such as leuprolide. Table 3 compares some of the agents used for the treatment of menorrhagia. Surgical options for abnormal uterine bleeding include operative hysteroscopy, myomectomy, transcervical endometrial resection, endometrial ablation, uterine artery embolization, and hysterectomy.[8] A detailed discussion of surgical options for menorrhagia is beyond the scope of this review.

The management of menorrhagia in patients with thrombocytopenia can be a particularly challenging dilemma for clinicians since many of the agents are potentially inappropriate, if not contraindicated, in women with neutropenia and/or thrombocytopenia. Thrombocytopenia may be a result of a malignancy or may be caused by myelosuppressive chemotherapy, radiation therapy, platelet consumption, coagulopathies, or other drugs.[28–30]

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