Radiotherapy for inoperable and refractory endometriosis presenting with massive hemorrhage: a case report

Takuma Nomiya, Mayumi Harada, Hiroko Sudo, Ibuki Ota, Mayumi Ichikawa, Motohisa Suzuki, Misako Murakami, M. Murakami, Kenji Nemoto
Journal of medical case reports · 2012 · vol. 6(1) , pp. 308 · doi:10.1186/1752-1947-6-308 · PMID:22989261 · PMC3462141 · W2169837872
article OA: gold CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

Radiotherapy successfully treated a patient with refractory, inoperable endometriosis causing massive hemorrhage by inducing menopause and inhibiting genital bleeding without side effects.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 ⓘ

This open-access case report describes a 47-year-old woman with long-standing endometriosis complicated by bilateral ovarian “chocolate cysts,” presumed adenomyosis and uterine myomas, whose massive atypical genital bleeding persisted despite hormonal therapies and who was deemed inoperable due to severe idiopathic thrombocytopenic purpura (platelets <10,000/mm³). The patient received pelvic radiotherapy totaling 20 Gy in 10 fractions to include the bilateral ovaries, uterus, and myomas, with an additional 10 Gy in 5 fractions to the endometrium to control residual bleeding; bleeding severity was tracked using daily self-assessment because precise blood-volume measurement was difficult. Genital bleeding decreased by day 14 and was completely inhibited by day 46, with no recurrence and no further transfusions for two years, while serum estradiol rapidly fell and FSH/LH rose consistent with treatment-induced post-menopausal status. The authors specifically note the key limitation that radiotherapy causes irreversible loss of ovarian function. This paper is centrally about endometriosis — it reports radiotherapy as a successful treatment for medication-refractory and inoperable endometriosis presenting with massive hemorrhage.

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Abstract

INTRODUCTION: Many patients with endometriosis are treated with medication or by surgical approaches. However, a small number of patients do not respond to medication and are inoperable because of comorbidities. This case report shows the effectiveness of radiotherapy for refractory endometriosis and includes a time series of serum estradiol levels. CASE PRESENTATION: A 47-year-old Asian woman presented to our facility with uncontrolled endometriosis refractory to medication. Our patient was considered inoperable because of severe idiopathic thrombocytopenic purpura, and underwent radiotherapy for massive genital bleeding requiring blood transfusions. A radiation dose of 20Gy in 10 fractions was delivered to the pelvis, including the bilateral ovaries, uterus, and myomas. An additional 10Gy in five fractions was delivered to the endometrium to control residual bleeding. Genital bleeding was completely inhibited on day 46 after radiotherapy. Hormonal analysis revealed that radiotherapy induced post-menopausal status. Two years after radiotherapy, atypical genital bleeding had not recurred and has been well controlled without side effects. CONCLUSIONS: Disrupted ovarian function is an adverse effect of radiotherapy. However, radiotherapy can be useful for inducing menopause. In cases of medication-refractory or inoperable endometriosis, radiotherapy would be an effective treatment option.

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endometriosis

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