Menstrual suppression

Hormonal therapies to reduce or stop menstrual bleeding have long been used to manage a number of gynecologic conditions including menstrual cramps (dysmenorrhea), heavy menstrual bleeding, irregular or other abnormal uterine bleeding, menstrual-related mood changes (Premenstrual Syndrome/PMS or Premenstrual Dysphoric Disorder/PMDD), and pelvic pain due to endometriosis or uterine fibroids.[1][7][8][2][9] Medical conditions that are associated with anemia or excessive blood loss, including sickle cell disease, iron deficiency anemia, Fanconi anemia, von Willebrand disease, low platelets (thrombocytopenia) from immune thrombocytopenia, or other blood/hematologic disorders such as clotting factor deficiencies could all benefit from menstrual suppression.[1][2] In patients with malignancies who will receive chemotherapy that could result in low blood counts or anemia, or individuals with recurrent malignancies who will receive a stem cell transplant, excessive menstrual bleeding during this treatment could be medically serious, and thus menstrual suppression might be indicated.[1][10] In addition, there are a number of other medical conditions with menstrual exacerbation that may benefit from menstrual suppression, including catamenial seizures, menstrual migraine headaches, irritable bowel syndrome, asthma . [1]

Menstrual hygiene issues, as in those individuals with developmental delay or intellectual disability or other manual dexterity or mobility/wheelchair challenges such as spina bifida or cerebral palsy may prompt an individual or caregiver to request menstrual suppression.[11][12] Job or activity-related indications for menstrual suppression may include deployed military as occurred during Operation Desert Storm, travel, wilderness camping, or athletes with concerns about menses occurring during competition or training.[1] There is also a growing recognition that some individuals who were at assigned female at birth, but who now identify as male (transgender men) or non-binary, may experience dysphoria with menses, and thus may request medical therapy for menstrual suppression.[13][14]

The use of hormonal methods containing estrogen (combined oral contraceptives, the contraceptive patch or contraceptive ring), may be associated with risks that outweigh benefits for individuals with specific medical problems, such as migraine headaches with aura, a history of breast cancer, or a history of deep vein thrombosis.[15] Thus these options would be contraindicated for menstrual suppression with such conditions. Progestin-only options (depot medroxyprogesterone acetate, oral progestins) are appropriate for these individuals. Drug-drug interactions are also important to consider, particularly with combined hormonal options.

Because extended cycle regimens of combined hormonal contraceptives provide a greater cumulative dose of steroid hormones, questions have been raised about their safety. Data currently provide reassurance that these options are safe.[7][8][16]

Historically, the concept that menstruation did not have beneficial effects, and that menstruation could be controlled was raised in the 1990s, by Dr. Elsimar Coutinho.[19] The English language version, title, "Is Menstruation Obsolete: How suppressing menstruation can help women who suffer from anemia, endometriosis, or PMS?" was published in 1999.

The concept that women can choose when and whether to menstruate has been debated. The Society for Menstrual Cycle Research maintains that menstruation is not a disease, and thus calls for more research on long-term effects of cycle-stopping contraceptives.[20] Most evidence to date supports the safety of menstrual suppression. [7][8][16]