INTRODUCTION

Several hormonal contraceptives are available that 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 "Initial approach to the premenopausal woman with abnormal uterine bleeding" and "Chronic menorrhagia or anovulatory uterine bleeding" and "Overview of the use of estrogen-progestin contraceptives".)

BENEFITS OF MENSTRUAL SUPPRESSION

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 [1]. Moreover, this frequent, regular ovulation may actually increase a woman's risk of some diseases, such as 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 OC formulations that result in withdrawal bleeding each four weeks was entirely arbitrary.

Medical benefits — Suppression of menstruation can be beneficial in prevention or treatment of several medical conditions. The mechanism involves a reduction in the volume and frequency of uterine bleeding or a reduction in normal cyclic hormonal fluctuations.

• Reduction in risk of ovarian and endometrial cancer — (see "Risks and side effects associated with estrogen-progestin contraceptives", section on 'Risk of cancer').
• Relief of dysmenorrhea — (see "Primary dysmenorrhea in adult women: Clinical features and diagnosis" and "Treatment of primary dysmenorrhea in adult women").
• Prevention and treatment of menorrhagia — (see "Chronic menorrhagia or anovulatory uterine bleeding").
• Prevention and treatment of anemia in women with bleeding diatheses — (see "Clinical presentation and diagnosis of von Willebrand disease" and "Heavy or irregular uterine bleeding during chemotherapy").
• Prevention and treatment of excessive bleeding related to uterine leiomyoma or adenomyosis — Some women with heavy menstrual bleeding associated with leiomyomas respond to contraception which suppresses menstruation. (See "Overview of treatment of uterine leiomyomas (fibroids)".)
• Treatment of pain related to endometriosis — (see "Overview of the treatment of endometriosis").
• Prevention of menstrual migraine — (see "Estrogen-associated migraine").
• Management of symptoms related to premenstrual syndrome — (see "Clinical manifestations and diagnosis of premenstrual syndrome and premenstrual dysphoric disorder" and "Treatment of premenstrual syndrome and premenstrual dysphoric disorder").