Hematological malignancy presenting as menorrhagia – A rare but real association!!

Irregularities in the menstrual cycle involving frequency, duration, and volume of flow are known as abnormal uterine bleeding (AUB). The prevalence of AUB is estimated to be between 3% and 30% among reproductive-aged women with a higher incidence at perimenopause and menarche. The most common causes of AUB are structural including adenomyosis, leiomyoma, endometrial polyps, and solid malignancy. The more elusive and less common causes are non-structural, including ovulatory disorders and coagulopathy. However, menorrhagia as a presenting feature of an uncommon hematological malignancy, myelodysplastic syndrome (MDS), is rarely described. We report the case of a 40-year-old woman of Indian origin who presented with chronic AUB. The patient was recently diagnosed with immune thrombocytopenia and underwent operative intervention for a frontal lobe meningioma. Subsequently, her uterine bleeding worsened, and she presented to our institute in the gynecology emergency department. Laboratory examination revealed pancytopenia, and upon extensive hematological workup, she was diagnosed with MDS. To the best of review of literature, such a gynecological presentation of an underlying hematological malignancy is extremely rare. This case illustrates that a high index of suspicion should be considered by clinicians in women presenting with AUB in conjunction with cytopenias. A multidisciplinary approach and hematological consultation should be kept in mind for timely evaluation and management in such cases.