Use of GnRH Analog Combined with Parenteral Progesterone Following Intravenous Estrogen Administration in the Treatment of Life-Threatening Dysfunctional Uterine Bleeding: A Case Report - Abstract
Objective: To report a case of life-threatening anovulatory dysfunctional uterine bleeding (DUB) successfully treated without the use of oral contraceptives. Design: Case reportSetting: Academic centerPatient: A 15-year-old female with autism presented with confusion, severe anovulatory vaginal bleeding and inability to tolerate oral contraceptives. Intervention: Parenteral hormone induction of amenorrhea Main Outcome Measures: Control of life-threatening anovulatory DUBResult: High-dose intravenous estradiol therapy was started immediately and followed by three-months of gonadotropin-releasing hormone (GnRH) analog therapy (leuprolide acetate, 3.75 mg intramuscular, monthly) rather than oral contraceptive administration. With the onset of pituitary desensitization to GnRH, GnRH analog therapy was replaced with medroxyprogesterone acetate (medroxyprogesterone acetate, 150 mg intramuscularly every 3 months) to provide longer control of abnormal menstrual bleeding. Conclusion: The use of GnRH analog in combination with parenteral progestin administration may be a reasonable first-line alternative to oral contraceptives following intravenous estrogen administration to treat life-threatening DUB in women unable to use oral steroid hormones.