Considerations for Menstrual Suppression in Patients With Hematologic Malignancies

Patients who menstruate during treatment for hematologic malignancies have a higher risk of heavy vaginal bleeding due to thrombocytopenia caused by malignancy and myelosuppressive chemotherapy. Heavy menstrual bleeding is associated with significant morbidity in this patient population, and menstrual suppression is a standard of supportive care. Options for prophylactic menstrual suppression include gonadotropin-releasing hormone agonists, progestin-only therapy, and combined hormonal contraception. Various factors impact the choice of menstrual suppression agent, including efficacy, presence of emergent acute uterine bleeding, desire for contraception, and presence of thrombotic risk factors. The purpose of this review is to discuss the nuances of available menstrual suppression agents in patients with hematologic malignancies and develop a methodical approach to consider patient-specific factors that impact agent selection.