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

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