Menstrual suppression

Source: Wikipedia, the free encyclopedia.

Menstrual suppression refers to the practice of using

menstrual bleeding. In contrast to surgical options for this purpose, such as hysterectomy or endometrial ablation
, hormonal methods to manipulate menstruation are reversible.

There are a number of

transmasculine people who may experience dysphoria with menstruation.[5]
Menstrual suppression is also being used by individuals with a variety of personal reasons to have less frequent or no menses, including honeymoon, vacations, travel, or other specific reasons.

Options for menstrual suppression include

breakthrough bleeding") can occur; for many options for menstrual suppression, breakthrough bleeding becomes less frequent with time.[8]

Medical uses

Hormonal therapies to reduce or stop

migraine headaches, irritable bowel syndrome, and asthma.[1]

transmasculine people may experience dysphoria with menses, and thus may request medical therapy for menstrual suppression.[15][16]

Contraindications

The use of hormonal methods containing estrogen (

migraine headaches with aura, a history of breast cancer, or a history of deep vein thrombosis.[17] 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.[citation needed
]

Safety

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.[9][10][18]

Options

While some forms of

LH surge. Inhibition of follicular development and the absence of an LH surge prevent ovulation.[19][20][21]

Combined hormonal contraceptives

The use of

extended cycle combined hormonal contraceptive pills are commonly used for menstrual suppression, although breakthrough bleeding is common in the initial months of use. The rate of amenorrhea
(no bleeding) is in the range of 60% for users who are continuing to use combined hormonal contraceptive pills at the end of a year.

Combined hormonal contraceptives include both an estrogen and a progestogen. Estrogen negative feedback on the

withdrawal bleeding. In a normal cycle, menstruation occurs when estrogen and progesterone levels drop rapidly.[23] Temporarily discontinuing use of combined hormonal contraceptives (a placebo week, not using patch or ring for a week) has a similar effect of causing the uterine lining to shed. If withdrawal bleeding is not desired, combined hormonal contraceptives may be taken continuously, although this increases the risk of breakthrough bleeding.[medical citation needed
]

Progestogen-only contraceptives

depot medroxyprogesterone acetate (DMPA; Depo-Provera) do not contain an estrogen. DMPA is given as an injection every 90 days, and is typically associated with amenorrhea in about 50 to 60% of users at the end of one year. Progestogens that are not typically used for birth control, such as norethisterone acetate, may be used to induce amenorrhea.[24]

The degree of

hormonal intrauterine devices (IUDs) (e.g., levonorgestrel (Mirena)), inhibit ovulation in about 50% of cycles and rely mainly on other effects, such as thickening of cervical mucus, for their contraceptive effectiveness.[25] Intermediate-dose progestogen-only contraceptives, including the progestogen-only pill desogestrel (Cerazette) and the subdermal implant etonogestrel (Nexplanon, Implanon), allow some follicular development but more consistently inhibit ovulation in 97 to 99% of cycles. The same cervical mucus changes occur as with very low-dose progestogens. High-dose progestogen-only contraceptives—the injectables DMPA (Depo-Provera) and norethisterone enanthate (Noristerat)—completely inhibit follicular development and ovulation.[25]

Injections such as DMPA became available in the 1960s and later became used to also achieve amenorrhea. A majority of patients will achieve amenorrhea within 1 year of initiating DMPA therapy. DMPA therapy is typically successful in achieving amenorrhea but also has side effects of decreased

bone mineral density that must be considered before beginning therapy.[12]

When using the subdermal progestogen-only implants, unpredictable bleeding continues and amenorrhea is not commonly achieved amongst patients.

metrorrhagia). Irregular and prolonged bleeding is the most common reason that women discontinue using the mini pill.[26]

Hormonal IUDs containing the progestogen levonorgestrel have the side effect of inducing amenorrhea, and some types of IUDs have been shown to markedly decrease menstrual blood loss, and thus are efficacious in treating heavy and abnormal menstrual bleeding.[27] The rate of amenorrhea after one year of use is in the range of 20 to 50%, although most users of the hormonal IUDs Mirena and Liletta experience a marked decrease in menstrual bleeding, which is beneficial and has led to reported high rates of user satisfaction.

Levonorgestrel IUDs have also been used been shown to induce amenorrhea. The lower dose device has a lower rate of achieving amenorrhea compared to the higher dose device where 50% of users have been found to achieve amenorrhea within 1 year of use. A concern for usage of these devices is the invasive administration and initial breakthrough bleeding while utilizing these devices however they have the advantage of the most infrequent dosing schedule of every 5 years. Use of IUDs have also shown to reduce menorrhagia and dysmenorrhea.[12][28]

Others

GnRH antagonists, are associated with amenorrhea, and have been used to induce therapeutic amenorrhea. Among oncologists caring for adolescents with cancer, GnRH modulators were the most commonly recommended treatment for menstrual suppression to prevent or treat heavy bleeding during therapy.[12]

The

transmasculine
people, there has been some consideration of this option for menstrual population in this group of individuals.

anabolic–androgenic steroids, such as nandrolone and oxandrolone
, may also produce menstrual suppression at sufficiently high doses.

History

Historically, women and girls had far fewer menstrual periods throughout their lifetimes, a result of shorter life expectancies, as well as a greater length of time spent pregnant or breast-feeding, which reduced the number of periods they experienced.[29]

When the first birth control pill was being developed, the researchers were aware that they could use the contraceptive to space menstrual periods up to 90 days apart, but they settled on a 28-day cycle that would mimic a natural menstrual cycle and produce monthly periods. The intention behind this decision was the hope of the inventor, John Rock, to win approval for his invention from the Roman Catholic Church. That attempt failed, but the 28-day cycle remained the standard when the pill became available to the public.[30]

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.[31] 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.

References

  1. ^
    S2CID 43436578
    .
  2. ^
    PMID 11239613
    .
  3. PMID 24161307
    .
  4. PMID 20134299
    .
  5. S2CID 186205682
    .
  6. ^
    S2CID 113407509
    .
  7. PMID 25018654
    .
  8. PMID 17521249
    .
  9. ^
    PMID 26572318
    .
  10. ^
    PMID 25072731
    .
  11. PMID 17046376
    .
  12. ^
    S2CID 201618230
    .
  13. S2CID 4444056
    .
  14. PMID 20134299
    .
  15. S2CID 205798509
    .
  16. S2CID 113407509
    .
  17. PMID 27467196
    .
  18. S2CID 28881452
    .
  19. ^
    ISBN 978-0-9664902-0-6
    .
  20. ^
    ISBN 978-0-7817-6488-9
    .
  21. ^
    ISBN 978-0-07-142280-2
    .
  22. PMID 19209272
    .
  23. ^ Weschler 2002, pp. 361–2.
  24. PMID 25018654
    .
  25. ^
    ISBN 978-0-7216-0376-6
    .
  26. PMID 8982741
    .
  27. PMID 23635628
    .
  28. PMID 26126950
    .
  29. ISBN 978-0-313-34039-0
    .
  30. ^ "Do you really need to have a period every month?". Discovery Health. 27 January 2009. Archived from the original on 8 February 2013. Retrieved 20 September 2011.
  31. OCLC 65181385
    .
Retrieved from "https://en.wikipedia.org/w/index.php?title=Menstrual_suppression&oldid=1219017712"