A case of fatal pulmonary thromboembolism associated with the use of intravenous estrogen therapy

Abstract

Objective: To report a case of fatal pulmonary embolism associated with the use of IV estrogen therapy for menometrorrhagia.

Design: Case report.

Setting: University hospital.

Patient(s): A 52-year-old woman with fibroid uterus treated with GnRH analogues with add-back therapy who presented with excessive vaginal bleeding.

Intervention(s): Intravenous conjugated estrogens were administered for a total of six doses.

Main Outcome Measure(s): Fatal thromboembolic event.

Result(s): The day after IV conjugated estrogens were administered, the patient had only scant vaginal bleeding, but she experienced the sudden onset of respiratory distress, became comatose, and subsequently had ventricular fibrillation leading to asystole. All resuscitative efforts failed. Postmortem examination revealed bilateral pulmonary artery thromboembolism (saddle embolus).

Conclusion(s): Intravenous conjugated estrogen therapy may be complicated by fatal thromboembolic events. This potential adverse effect must be considered in the use of such therapy for severe menometrorrhagia, especially when treating a patient at increased risk.