Conjugated hyperbilirubinemia in the clinical setting of hematopoietic stem
cell transplantation can have multiple etiologies that may prompt various
therapeutic interventions. Two patients who received short courses of a hig
h-dose estrogen-progesterone combination to treat breakthrough menstrual bl
eeding during transplant are reported. Conjugated hyperbilirubinemia develo
ped in both patients within days of beginning therapy and resolved after th
e ethinyl estradiol and norgestrel (Ovral; Pharmacia and Upjohn, Kalamazoo,
MI, U.S.A.) was discontinued. In one of the patients, this occurred on thr
ee separate occasions during the course of transplantation. Recognizing the
cholestatic effect of estrogens during transplantation may prevent unneces
sary alterations in therapy beyond the simple discontinuation of these medi
cations.