Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Heavy or irregular uterine bleeding during chemotherapy

Andrea Milbourne, MD
Section Editors
Barbara Goff, MD
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Chemotherapy-induced thrombocytopenia can lead to menorrhagia (ie, heavy and prolonged menses) or irregular bleeding in premenopausal women, including adolescents [1], whereas uterine bleeding is a rare complication of chemotherapy-induced thrombocytopenia in postmenopausal women. Premenopausal women treated with alkylating agents are also at risk of development of hypogonadotropic amenorrhea.

This topic review will address management of menorrhagia related to chemotherapy. Ovarian failure related to anticancer drugs is discussed separately. (See "Ovarian failure due to anticancer drugs and radiation".)


There are three potential cancer-related causes of uterine bleeding:

Bleeding directly from a genitourinary neoplasm (eg, endometrial carcinoma, gestational trophoblastic disease, cervical cancer)

Bleeding secondary to thrombocytopenia induced by chemotherapy, radiation therapy, and/or the malignancy itself (eg, acute promyelocytic leukemia, non-Hodgkin lymphoma)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Mar 30, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Committee opinion no. 606: Options for prevention and management of heavy menstrual bleeding in adolescent patients undergoing cancer treatment. Obstet Gynecol 2014; 124:397.
  2. Lhommé C, Brault P, Bourhis JH, et al. Prevention of menstruation with leuprorelin (GnRH agonist) in women undergoing myelosuppressive chemotherapy or radiochemotherapy for hematological malignancies: a pilot study. Leuk Lymphoma 2001; 42:1033.
  3. Stabinsky SA, Einstein M, Breen JL. Modern treatments of menorrhagia attributable to dysfunctional uterine bleeding. Obstet Gynecol Surv 1999; 54:61.
  4. Laufer MR, Townsend NL, Parsons KE, et al. Inducing amenorrhea during bone marrow transplantation. A pilot study of leuprolide acetate. J Reprod Med 1997; 42:537.
  5. Ghalie R, Porter C, Radwanska E, et al. Prevention of hypermenorrhea with leuprolide in premenopausal women undergoing bone marrow transplantation. Am J Hematol 1993; 42:350.
  6. Chiusolo P, Salutari P, Sica S, et al. Luteinizing hormone-releasing hormone analogue: leuprorelin acetate for the prevention of menstrual bleeding in premenopausal women undergoing stem cell transplantation. Bone Marrow Transplant 1998; 21:821.
  7. Meirow D, Rabinovici J, Katz D, et al. Prevention of severe menorrhagia in oncology patients with treatment-induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate. Cancer 2006; 107:1634.
  8. Amsterdam A, Jakubowski A, Castro-Malaspina H, et al. Treatment of menorrhagia in women undergoing hematopoietic stem cell transplantation. Bone Marrow Transplant 2004; 34:363.
  9. Kropsky B, Shi Y, Cherniack EP. Incidence of deep-venous thrombosis in nursing home residents using megestrol acetate. J Am Med Dir Assoc 2003; 4:255.
  10. van den Heuvel MW, van Bragt AJ, Alnabawy AK, Kaptein MC. Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception 2005; 72:168.
  11. Thürlimann B, Castiglione M, Hsu-Schmitz SF, et al. Formestane versus megestrol acetate in postmenopausal breast cancer patients after failure of tamoxifen: a phase III prospective randomised cross over trial of second-line hormonal treatment (SAKK 20/90). Swiss Group for Clinical Cancer Research (SAKK). Eur J Cancer 1997; 33:1017.
  12. Hägglund H, Remberger M, Klaesson S, et al. Norethisterone treatment, a major risk-factor for veno-occlusive disease in the liver after allogeneic bone marrow transplantation. Blood 1998; 92:4568.
  13. Jack SA, Cooper KG, Seymour J, et al. A randomised controlled trial of microwave endometrial ablation without endometrial preparation in the outpatient setting: patient acceptability, treatment outcome and costs. BJOG 2005; 112:1109.
  14. Qian Y, Gan N, Zhou J, et al. Microwave endometrial ablation for menorrhagia in patients with systemic disorders. Int J Gynaecol Obstet 2005; 91:32.
  15. Phelan JT 2nd, Broder J, Kouides PA. Near-fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: a case report of bilateral uterine artery embolization. Am J Hematol 2004; 77:151.