Combined oestrogen-progestin treatment of vaginal haemorrhage following gonadotrophin-releasing hormone agonist therapy of uterine myomas.

Three pre-menopausal women with uterine myomas were treated with leuprolide acetate depot and experienced profuse vaginal bleeding 7-11 weeks after initiation of treatment, despite profound oestradiol suppression. In each case, leuprolide therapy was discontinued and the women were treated with combination oral contraceptives and ferrous sulphate. Vaginal bleeding ceased within 24-48 h of oral contraceptive treatment in all women. Haemoglobin concentrations were restored to normal values and all women underwent definitive surgical treatments after 4-6 weeks of oral contraceptive treatment without the need for homologous blood transfusion. The final pathology report revealed focal necrosis of submucous myomas in all cases.