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Obstet Gynecol. 1971 Oct;38(4):589-93.

Therapeutic amenorrhea in hematologic disorders.



The feasibility of medical control of and prevention of uterine bleeding secondary to hematologic disease by the induction of prolonged amenorrhea with steroids was investigated. 29 patients were treated during a 30-month period. Mean age was 25.7 years and mean parity was 1.8. Acute lukemia and immune thrombocytopenic purpura were the most frequently primary diseases. Chronic lukemia, chronic renal disease, and aplastic anemia were also diagnosed. In 23 women menorrhagia had an unfavorable effect on the primary illness and in 14 it was present when treatment began. All platelet counts were very low. 3 drug regimens were used: 1) norethynodrel + mestranol, 2) depomedroxyprogesterone acetate (DMPA), and 3) DMPA + conjugated estrogens. Significant breakthrough bleeding occurred in 7 patients (24%) and was not related to the degree of thrombocytopenia. Average length of treatment was 15.3 weeks. During the study 18 patients died of their primary disease. Treatment was discontinued in 7 because of improvement in the primary disease. In 4 treatment is being continued. As DMPA is released slowly, in 10 urgent cases iv conjugated estrogens were given until bleeding was controlled or medroxyprogesterone acetate was given orally for a few days. Results show the feasibility of this method of producing therapeutic amenorrhea in the management of a variety of hematologic diseases. Fluid retention was more frequent with high estrogen dosage.

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