July 10th, 2020

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Management of Menstrual Bleeding During Treatment for Nongynecologic Malignancy
Authors:  Kiila N. Johnson, M.D., Pietro Bortoletto, M.D., Douglas Gilchrist-Scott, M.D., and Dana R. Gossett, M.D.
  OBJECTIVE: To assess current practices for menstrual suppression and identify the frequency of significant vaginal bleeding among women undergoing treatment for nongynecologic cancers.

STUDY DESIGN: Retrospective case-control study of women with nongynecologic malignancies at Northwestern Memorial Hospital 2008–2013. Women with an episode of bleeding after initiation of cancer treatment were matched by age, cancer type, and year of diagnosis with women without bleeding. McNemar-Bowker, paired t tests, and χ2 analyses estimated differences between groups.

RESULTS: A total of 83 cases with vaginal bleeding were identified and matched with 83 controls. Mean age was 45.3. The most common diagnoses were breast (68.6%), hematologic (12.0%), and thyroid (10.8%) cancers. Of the cases, 79 received gynecologic consultation (95.2%); 37 required intervention. Interventions included dilation and curettage (54.1%), oral contraceptive pills (16.2%), levonorgestrel IUD (16.2%), and hysterectomy (16.2%). Few patients (10.2%) received menstrual suppressive therapy, but suppressive therapy was more common among cases (15.7% vs. 4.8%; p=0.04), hematologic malignancies (29.4% vs. 10.1%; p<0.001), younger women (age <40; p<0.001), and women receiving chemotherapy (70.6% vs. 45.6%; p=0.02).

CONCLUSION: Among women with nongynecologic cancers, thrombocytopenia can result in significant vaginal bleeding, yet menstrual suppression is underutilized. Education should be increased to minimize complications and encourage wider utilization among women of childbearing age.
Keywords:  chemotherapy, contraception, hypermenorrhea, menorrhagia, menstrual cycle, menstruation, thrombocytopenia, uterine bleeding, uterine hemorrhage
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