Use and Effectiveness of Gonadotropin-Releasing Hormone Agonists for Prophylactic Menstrual Suppression in Postmenarchal Women Who Undergo Hematopoietic Cell Transplantation.
OBJECTIVE
To describe the rates of use and effectiveness of gonadotropin-releasing hormone (GnRH) agonists and other forms of hormonal menstrual suppression in prevention of vaginal bleeding among young women who underwent hematopoietic stem cell transplantation (HCT).


METHODS
Retrospective descriptive study.


METHODS
University-based pediatric HCT practice.


METHODS
Fifty-five postmenarchal women who underwent HCT between 2004 and 2011.


METHODS
Administration of GnRH agonists or other forms of hormonal menstrual suppression.


METHODS
Rates of use of GnRH agonists and other forms of hormonal menstrual suppression, and rates and descriptions of vaginal bleeding.


RESULTS
Forty-six of the 55 patients had experienced regular or irregular vaginal bleeding before HCT and were considered to be at risk for thrombocytopenia-associated menorrhagia. Forty of the 46 (87%) received hormonal menstrual suppression. Thirty-three patients were treated with a GnRH agonist, 4 with combined hormonal contraceptive pills, 1 with a combined hormonal contraceptive patch, 1 with depot medroxyprogesterone, and 1 with oral norethindrone. Twenty-nine of the 33 patients (88%) who received a GnRH agonist had complete amenorrhea during HCT and 4 of 33 (12%) experienced some degree of vaginal bleeding.


CONCLUSIONS
GnRH agonists appear effective in prevention of vaginal bleeding complications in most postmenarchal women who underwent HCT. Some patients who might benefit do not receive a GnRH agonist and multiple barriers exist in identification and treatment of them.
Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. Electronic address: ppoorvu@partners.org.
Philip D
PD
Poorvu
Heartland Center for Reproductive Medicine, Omaha, Nebraska.
Sara E
SE
Barton
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Christine N
CN
Duncan
Department of Medicine, Boston Children's Hospital, Boston, Massachusetts.
Wendy B
WB
London
Department of Obstetrics and Gynecology, Brigham and Women's Hospital; Division of Gynecology, Boston Children's Hospital, Boston, Massachusetts.
Marc R
MR
Laufer
Department of Pediatric Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
Leslie E
LE
Lehmann
Department of Radiation Oncology, Boston Children's Hospital, Dana-Farber Cancer Institute, and Brigham and Women's Hospital, Boston, Massachusetts.
Karen J
KJ
Marcus
D000293:Adolescent; D000328:Adult; D000568:Amenorrhea / Q000139:chemically induced*; D002648:Child; D003271:Contraceptive Agents, Female / Q000008:administration & dosage; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D017273:Goserelin / Q000008:administration & dosage; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D016729:Leuprolide / Q000008:administration & dosage; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014592:Uterine Hemorrhage / Q000209:etiology / Q000517:prevention & control*; D055815:Young Adult
D003271:Contraceptive Agents, Female; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide
Gonadotropin-releasing hormone; Hematopoietic stem cell transplantation; Menorrhagia