CONICET | Buscador de Institutos y Recursos Humanos

Introduction: Idiopathic thrombocytopenic purpura (ITP) may be manifested by a variety of symptoms including abnormal uterine bleeding, usually starting at menarche. There are different approaches to prevent menometrorrhagia in these patients, including therapeutic amenorrhea with GnRH analogues, progestagens alone and oral contraceptives. Objective: to describe clinical presentation and analyze the therapeutic strategies adopted to prevent metrorrhagia in patients with idiopathic thrombocytopenic purpura treated in our division. Subjects and methods: 22 patients with ITP (3 classified as acute and 19 as chronic), chronologic age 13. 4 ± 1.5 years (mean ± SD) were evaluated during the last 16 years. Gynecologic age at the moment of metrorrhagia, treatment and evolution were retrospectively analyzed. Results: Menarche occurred at 12.4 ± 1. 35 years in 19 girls (3 were premenarcheal). Fourteen patients presented metrorrhagia at a mean gynaecologic age of 11.3months. In 7 girls the metrorrhagia was the first symptom of the disease leading to diagnosis and in 4 patients the metrorrhagia appeared at menarche. Although they did not have metrorrhagia, six girls ( 2 premenarcheal ) were treated preventively. Twelve patients were managed with GnRH analogues, 4 with combined oral contraceptives, and 4 with only progestagens. Duration of therapy was 6.9 ± 4.8 months. Four patients are still under treatment. Five patients on the GnRH analogue group presented spotting, and two of them required shortening the application interval to 21 days. Only two patients had metrorrhagia during treatment, one on the oral contraceptive group and the other on the progestagen group. Conclusion: In the present series, GnRH analogue was the most effective treatment to prevent metrorrhagia in patiens with ITP. Further studies involving larger groups of patients are required.