North Carolina Cancer Hospital, University of North Carolina Hospitals and Clinics, Chapel Hill, North Carolina, USA.
Pharmacotherapy. 2011 Nov;31(11):1092-110. doi: 10.1592/phco.31.11.1092.
Abnormal uterine bleeding in women with a blood dyscrasia, such as leukemia, or who experience thrombocytopenia secondary to myelosuppressive chemotherapy is a clinical condition associated with significant morbidity. Consequently, effective management is necessary to prevent adverse outcomes. Prevention of menorrhagia, defined as heavy regular menstrual cycles with more than 80 ml of blood loss/cycle or a cycle duration longer than 7 days, in this patient population is the goal of therapy. Gonadotropin-releasing hormone analogs (e.g., leuprolide) are promising therapies that have been shown to decrease vaginal bleeding during periods of thrombocytopenia and to have minimal adverse effects other than those associated with gonadal inhibition. In patients who experience menorrhagia despite preventive therapies, or in patients who have thrombocytopenia and menorrhagia at diagnosis, treatment is indicated. For these women, treatment options may include platelet transfusions, antifibrinolytic therapy (e.g., tranexamic acid), continuous high-dose oral contraceptives, cyclic progestins, or other therapies for more refractory patients such as danazol, desmopressin, and recombinant factor VIIa. Hormonal therapies are often the mainstay of therapy in women with menorrhagia secondary to thrombocytopenia, but data for these agents are sparse. The most robust data for the treatment of menorrhagia are for tranexamic acid. Most women receiving tranexamic acid in randomized trials experienced meaningful reductions in menstrual bleeding, and this translated into improved quality of life; however, these trials were not performed in patients with cancer. Further clinical trials are warranted to evaluate both preventive and therapeutic agents for menorrhagia in premenopausal women with cancer who are receiving myelosuppressive chemotherapy.
患有血液疾病（如白血病）或因骨髓抑制化疗导致血小板减少的女性出现异常子宫出血是一种与严重发病率相关的临床病症。因此，需要进行有效的管理以预防不良后果。预防月经过多（定义为出血量超过 80ml/周期或周期持续时间超过 7 天的频繁且规律的月经周期）是此类患者群体的治疗目标。促性腺激素释放激素类似物（例如亮丙瑞林）是一种有前途的治疗方法，已证明其可减少血小板减少期间的阴道出血，并且除了与性腺抑制相关的不良反应外，其他不良反应最小。对于那些尽管采取了预防治疗仍出现月经过多的患者，或那些在诊断时即患有血小板减少和月经过多的患者，需要进行治疗。对于这些女性，治疗选择可能包括血小板输注、抗纤维蛋白溶解治疗（例如氨甲环酸）、连续高剂量口服避孕药、周期性孕激素或其他治疗方法，如达那唑、去氨加压素和重组因子 VIIa 等更难治的患者。对于因血小板减少导致月经过多的女性，激素治疗通常是治疗的主要方法，但这些药物的数据很少。对于月经过多治疗，最有力的数据是氨甲环酸。大多数在随机试验中接受氨甲环酸治疗的女性的月经出血都有明显减少，并且这转化为生活质量的改善；然而，这些试验并未在癌症患者中进行。需要进一步的临床试验来评估接受骨髓抑制化疗的患有癌症的绝经前女性的月经过多的预防和治疗药物。
