Hormonal contraception for suppression of menstruation
- Andrew M Kaunitz, MD
Andrew M Kaunitz, MD
- Professor and Associate Chairman
- Department of Obstetrics and Gynecology
- University of Florida College of Medicine-Jacksonville
Several available hormonal contraceptives can be used to reduce or eliminate monthly uterine bleeding. The safety and efficacy of these methods make them desirable for women who have medical indications for suppression of menstruation, as well as those who simply want the convenience of not having a monthly bleed (whether or not they desire contraception).
Use of hormonal contraceptives for suppression of menstruation is reviewed here. Evaluation and management of women with abnormal uterine bleeding, as well as general principles of use of hormonal contraceptives, are discussed separately. (See "Approach to abnormal uterine bleeding in nonpregnant reproductive-age women" and "Management of abnormal uterine bleeding" and "Overview of the use of estrogen-progestin contraceptives".)
SAFETY OF MENSTRUAL SUPPRESSION
Continuous or long-term use of hormonal contraception is associated with the same medical risks as cyclic use of these medications . In contrast to women on cyclic regimens, women using continuous-dose regimens benefit from reduction of menstrual symptoms (eg, headache, genital irritation, tiredness, bloating, and pain) . We educate our patients that unscheduled bleeding is common on extended regimens.
Menstruation (ovulation followed by withdrawal bleeding) is not physiologically necessary. In fact, most modern women experience many more menstrual cycles in their lifetime than women in prior generations because of earlier menarche, fewer pregnancies, reduced duration of breastfeeding, and later menopause . Moreover, this frequent, regular ovulation may actually increase a woman's risk of some diseases, such as endometriosis and ovarian cancer.
The concept that monthly bleeding is healthy has been perpetuated by oral contraceptives (OC) that were initially designed to mimic the average length of a normal menstrual cycle. This "artificial" period had no medical benefits and the initial choice of 21/7 (monthly) OC formulations that result in withdrawal bleeding each four weeks was arbitrary.
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- SAFETY OF MENSTRUAL SUPPRESSION
- Medical benefits
- Special populations
- Cost savings
- THERAPEUTIC OPTIONS
- Estrogen-progestin regimens
- - Cyclic contraceptive pills
- - Extended and continuous use of contraceptive pills
- - Transdermal and transvaginal estrogen-progestin
- Progestin contraceptives
- - Levonorgestrel intrauterine contraception
- - Depot medroxyprogesterone acetate
- - Progestin implant
- - Norethindrone acetate
- Other drugs
- - Postmenopausal hormone therapy formulation
- - GnRH analogues
- - Progesterone receptor antagonists and modulators
- - Danazol
- IMPACT ON FERTILITY
- SUMMARY AND RECOMMENDATIONS