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Menstruation

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Shared care information

Most girls who require menstrual suppression will have been started on hormonal therapy prior to leaving the oncology unit. If there are any ongoing concerns please contact the oncology unit during working hours.

Suppression of menstruation

Menstrual suppression is usually needed for females who are having periods on protocols associated with significant thrombocytopenia. Auckland patients requiring treatment or prevention of menorrhagia should be discussed with the gynaecology service.

Patients who are at low risk of regular thrombocytopenia and have an episode of menorrhagia should have platelet support, oral tranexamic acid +/- high-dose medroxyprogesterone as treatment.

Patients who are likely to become thrombocytopenic should receive prophylaxis:

  • oral norethisterone 5 mg TDS PO. For breakthrough bleeding, increase the dose to 10 mg TDS. The most common complications include weight-gain, acne, mood swings, and the risk of hepatic veno-occlusive disease (HVOD) is increased. Also TDS dosing is difficult in patients on multiple medications already. It should be avoided if:
    • there is a risk of HVOD
       ◦ haemopoetic stem cell transplant (HSCT)
       ◦ Actinomycin D in Wilms' tumour or Rhabdomyosarcoma
       ◦ Myelotarg in AML
    • radiotherapy to the liver is planned
    • patients have a personal or family history of venous thromboembolic events.
  • Leuprorelin (Lucrin™) 3.75 mg SC monthly or 11.25 mg SC 3 monthly is a gonadotrophin releasing hormone agonist that induces amenorrhoea. Side-effects include oedema, dizziness, breast tenderness, weight gain, anorexia, painful injection site, mood change, and loss of bone density.

Treatment of breakthrough bleeding

  • Platelet support, oral tranexamic acid (15-25 mg/kg/dose PO TDS) +/- high-dose medroxyprogesterone in the event of menorrhagia.
  • If there is ongoing menorrhagia, the gynaecologists should be consulted. Surgical intervention is rarely required.

Intercurrent mucositis

Should an adolescent taking norethisterone experience severe mucositis precluding oral intake, the norethisterone administration may be temporarily interrupted. This may lead to a breakthrough bleed. Under such circumstances, maintain the platelet count > 30 x 109/l or start leuprorelin.

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  • Date last published: 01 February 2011
  • Document type: Clinical Guideline
  • Services responsible: National Child Cancer Network