Side Effect: Vaginal Bleeding or Heavy Menstrual Bleeding

What is Vaginal Bleeding or Heavy Menstrual Bleeding?

• Vaginal bleeding, refers to bleeding from the vagina that may or may not be part of the menstrual cycle.
• Heavy menstrual bleeding refers to excessive bleeding during a menstrual cycle.

Other ways to define this type of bleeding are based upon the amount of blood loss, the duration of bleeding, and the number of sanitary products that are needed per day during the bleeding period.

Excessive bleeding can significantly interfere with a woman’s quality of life.

What does Vaginal Bleeding or Heavy Menstrual Bleeding look like?

The appearance of vaginal bleeding can vary but often presents as bright red blood, with or without clots.

In patients with cancer, the bleeding can differ from what the patient recognizes as their normal menstrual cycle. This includes, but is not limited to:

• Bleeding in between menstrual cycles
• Increased duration of bleeding (example: a menstrual cycle lasting more than 7 days)
• Bleeding due to a low platelet count

Symptoms that occur from the excessive bleeding can include fatigue and weakness due to excessive blood loss and iron deficiency. Some women may also experience pelvic pain, bloating, and discomfort during menstruation.

Who gets Vaginal Bleeding or Heavy Menstrual Bleeding?

Vaginal bleeding and excessive menstrual bleeding can affect women of all ages, but most commonly affects women of reproductive age. Patients with cancer are at an increased risk due to a variety of factors including hormonal changes and cancer treatment.

Other causes of vaginal bleeding include: uterine fibroids, adenomyosis, polyps, endometrial hyperplasia, other malignancies, or radiation therapy to a gynecologic area. Below are more common cancers and therapies that may increase the risk for increased vaginal or menstrual bleeding:

• Cervical cancer
• Uterine/Endometrial cancer
• Ovarian cancer
• Radiation therapy to a gynecologic area

Below are common medications that can increase bleeding risk:

• Anticoagulants – apixaban (Eliquis®), rivaroxaban (Xarelto®), warfarin (Coumadin®), dabigatran (Pradaxa®), enoxaparin (Lovenox®), edoxaban (Lixiana®)
• Antiplatelets – clopidogrel (Plavix®), prasugrel (Effient®), ticagrelor (Brilinta®)
• Aspirin
• Certain types of chemotherapy that cause a low platelet count
• Over the counter NSAIDs (non-steroidal anti-inflammatory drugs) – naproxen (Aleve®), ibuprofen (Motrin®)

How long can Vaginal Bleeding last?

It is important to note that vaginal bleeding and heavy menstrual bleeding can vary between patients. Patients with cancer may have low platelet counts (the medical term for a low platelet count is called thrombocytopenia) in the middle of their chemotherapy cycles.

Thrombocytopenia after a cycle chemotherapy usually lasts 5-7 days, but may be longer for certain patients such as those with acute leukemia.

How to prevent Vaginal Bleeding or Heavy Menstrual Bleeding

To prevent vaginal bleeding or heavy menstrual bleeding, it is best to avoid known causes, when possible, such as certain medications that increase the risk of bleeding.

How to treat Vaginal Bleeding or Heavy Menstrual Bleeding

Vaginal or heavy menstrual bleeding can also be a sign of disease progression or complications related to treatment.

Treatment may involves medicine that helps stops bleeds, hwoever if bleeding cannot be adequately controlled, some patients may need blood transfusions if the hemoglobin (a marker of how much blood is in your bodu) drops to very low levels.

Treatment options to help reduce bleeding:

• Hormonal therapy, such as:
  • Medroxyprogesterone acetate (DepoProvera®)
  • Norethindrone acetate (Aygestin®)
  • Leuprolide (Lupron®)

• Surgery – to remove polyps, cancer, or fibroids causing the bleed.
• Tranexamic acid (Lysteda®) tablets
• Aminocaproic acid (Amicar®) tablets
• Vitamin K (available in tablets, or as a subcutaneous injection), usually reserved for people who are malnourished