[Genital bleeding secondary to chemotherapy in adolescent girls].
Severe genital bleeding during adolescence can occur in the event of thrombocytopenia related to chemotherapy. Preventive hormonal treatment to induce therapeutic amenorrhea is recommended by some clinicians. Nevertheless, the adverse effects of oestroprogestative treatment, such as thromboembolic risk or hepatic toxicity, could potentialize the adverse effects of some chemotherapies.


OBJECTIVE
To assess retrospectively the risk of genital bleeding associated with thrombocytopenia secondary to chemotherapy in a population of adolescent girls for whom therapeutic amenorrhea was induced or not.


METHODS
Among 140 girls, 12 to 18 years old, who were subjected to chemotherapy between 1991 and 1998, 24 girls presented at least one thrombocytopenic event (platelet level < 20 x 10(9) l(-1)) and were included.


RESULTS
Six out of 24 adolescent girls received hormonal therapy to induce amenorrhea. Only one bleeding event was observed, in a girl who had not received preventive oestroprogestative treatment. Vital prognosis was preserved. Furthermore, spontaneous amenorrhea occurring before chemotherapy was observed in 33% of the patients and permanent secondary ovarian insufficiency in 17% of the patients.


CONCLUSIONS
The risk of genital bleeding among adolescent population at risk of chemotherapy-induced thrombocytopenia is low. The high frequency of amenorrhea, secondary to weight loss or to chemotherapy toxicity, should raise questions as to the usefulness of preventive oestroprogestative treatment.
Bernier
M O
MO
Unité d'endocrinologie et gynécologie pédiatrique, hôpital Necker-enfants-malades, AP-HP, 149, rue de Sèvres, 75743 Paris cedex 15, France.
Duflos
C
C
Baruchel
A
A
Zucker
J M
JM
Thibaud
E
E
D000293:Adolescent; D000568:Amenorrhea / Q000139:chemically induced; D000970:Antineoplastic Agents / Q000009:adverse effects*; D002648:Child; D005260:Female; D005831:Genital Diseases, Female / Q000139:chemically induced*; D006470:Hemorrhage / Q000139:chemically induced*; D006801:Humans; D010049:Ovarian Diseases / Q000139:chemically induced / Q000150:complications; D012189:Retrospective Studies
D000970:Antineoplastic Agents