Meirow, D., Rabinovici, J., Katz, D., Or, R., & Ben-Yehuda, D. (2006). Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer, 107, 1634–1641.

Medical information was collected from a computer database. Patients received either DMPA or D- tryptophan -6-leutenizng hormone-releasing hormone agonist (GnRH-a) or no treatment before myelosuppressive chemotherapy.

 

• N = 101 (42 received DMPA, 39 received GnRH-a, 20 remained untreated)
• MEAN AGE = 29.8 years
• OTHER KEY SAMPLE CHARACTERISTICS: 93 had BMT, and eight had non-ablative regimens. Only patients who developed thrombocytopenia less than 25k were included in the study. Patients had confirmed ovarian function. Patients were excluded who were receiving hormonal therapy, including oral contraceptives, immediately prior to therapy.
   

• Retrospective clinical study

• Severe thrombocytopenia = platelets less than 25K
• Number of days of thrombocytopenia
• Number of blood units required
• ANOVA—if ANOVA 0.05 level paired comparisons with Mann-Whitney
• Multiple comparisons with Student-Newman-Keuls
• General bleeding, amount of bleeding, and number of gynecologic visits tested with chi-square
• Nonvaginal bleeding (1 = no bleeding, 2 = mild—mucosal bleeding or skin hemm, 3 = moderate bleeding—bleeding from major organ system, 4 = severe—life threatening)
• Vaginal bleeding (1 = none, 2 = spotting mild, 3 = moderate—daily blood loss comparable to regular menses but requiring intervention because of duration, 4 = significant, requiring intervention)

Four patients were excluded because of gynecologic pathology. Average days of thrombocytopenia was 24.75 +/- 23.6 days. There was no statistical significant difference between groups regarding duration of thrombocytopenia. There was no difference in moderate to severe nonvaginal bleeding. There was no difference in platelet /packed red blood cells and fresh frozen plasma transfusions. Moderate/severe vaginal bleeding occurred in 16.8%—both treatment groups had lower rates of menorrhagia than untreated groups. None of the GnRH-a group had moderate/severe vaginal bleeding (p-0.002). There was a need for urgent gynecologic consult—untreated versus treated (P < 0.0001). Urgent treatment with estrogen was needed in the DMPA group but not the GnRh-a group (P = 0.004).