Gonadotropin releasing hormone agonists are effective in long-term treatment of women with abnormal uterine bleeding and anticoagulant therapy: Report of 3 cases and review of the literature

Objectives: To evaluate the efficacy of GnRH agonists (GnRH-a) in women with abnormal uterine bleeding (AUB) on anticoagulant therapy. Materials and Methods:Prospective observational case series (Canadian Task Force Classification II-3) at a University affiliated teaching hospital.From January 2002 through July 2019, three premenopausal women with AUB on warfarin therapy were identified in our clinic.After clinical assessment, including Papanicolaou smear, endometrial biopsy, and pelvic sonography, a GnRH-a was used to treat their AUB.Results: Two women were receiving warfarin therapy (5-7 mg/d) for previous venous thromboembolism and one for mechanical heart valve replacement associated with Marfan's syndrome.All patients had significant additional comorbid conditions and were at high risk for traditional medical or surgical therapies.After treatment with GnRH-a, all women reported significant menstrual reduction at 3 months and remained amenorrhoeic for 2 to 11 years; two of whom reached menopause. Conclusion:In properly assessed and selected premenopausal women with AUB receiving anticoagulant therapy and at high risk for traditional therapies, long-term GnRH-a were effective treatment in 3 patients.