Committee opinion no. 606: Options for prevention and management of heavy menstrual bleeding in adolescent patients undergoing cancer treatment.

Adolescents undergoing cancer treatment are at high risk of heavy menstrual bleeding, and gynecologists may be consulted either before the initiation of cancer treatment to request strategies for menstrual suppression or during an episode of severe heavy bleeding to stop the bleeding emergently. Therapy in both situations should be tailored to the patient, her cancer diagnosis and treatment plan, and her desires for contraception and fertility. Options for menstrual suppression include combined hormonal contraceptives, progestin-only therapy, and gonadotropin-releasing hormone agonists. Adolescents presenting emergently with severe uterine bleeding may benefit from hormonal therapy, antifibrinolytics or, as a last resort, surgical management. In choosing appropriate treatment, considerations such as current platelet count, course of treatment, time to expected nadir, risk of thromboembolism, and need for contraception should be considered. Because of the complex nature of cancer care, collaboration with the adolescent's oncologist is highly recommended.