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Medical Menstruation Suppression Is a Safe, Desirable Option, Guidelines Say Everyday Health MenuNewslettersSearch Sexual Health
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Stopping Menstrual Periods Is Safe Experts SayNew guidelines from a leading gynecologist group describe a wide variety of scenarios where menstrual suppression may be beneficial, including when people have heavy bleeding, disability, military deployment, or gender dysphoria. By Meryl Davids LandauAugust 26, 2022Fact-CheckedThere are many good reasons — and different tools, including the shot, the pill, the patch, and the ring — to suppress menstruation and prevent monthly bleeding.iStock; Stocksy (2); Michael Kraus/Shutterstock (2)Hormonal medications are mostly used for birth control, but doctors shouldn’t forget another important use, suppressing menstruation, according to a new report from the American College of Obstetricians and Gynecologists (ACOG). The guidance, General Approaches to Medical Management of Menstrual Suppression, is especially timely given the growing concerns about future access to reproductive medical care, ACOG said in a statement.
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That’s partly why the organization wants to emphasize the role hormonal medications play beyond preventing pregnancy. Requests for Menstruation Suppression or Stopping Monthly Bleeding Are Common
The desire to stop periods, whether briefly or for a long time, is fairly widespread, says a coauthor of the report, Kathryn Stambough, MD, an adolescent gynecologist and an assistant professor of obstetrics and gynecology at the University of Arkansas for Medical Sciences. “Suppression of menstrual cycles is an area of request from many patients.”
Doctors aren’t always aware of all the options.
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And patients can harbor misconceptions about whether suppressing menstruation is safe. The guidance was meant to address these issues, says Oluyemisi Adeyemi-Fowode, MD, a pediatric and adolescent gynecologist in private practice in Sugarland, Texas, and the report’s coauthor.
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Aakriti Carrubba, MD, a gynecological surgeon at Mayo Clinic in Jacksonville, Florida, who was not involved with this report, says the document will be valuable for many physicians. “This guidance from ACOG is important because it provides a comprehensive, evidence-based overview of different ways that menses can be suppressed,” she says.
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While she herself frequently counsels patients on this topic, “other providers may have less familiarity with the available options, specifically with regard to contraindications and long-term management.”
RELATED: COVID-19 Can Mess With Your Period in Multiple Ways
In addition to being available online, the clinical consensus will be published in the medical journal Obstetrics & Gynecology in September. Who Benefits From Suppressing Menstruation
The report details the wide array of people who sometimes desire to suppress their periods hormonally.
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They include:Women who don’t want the discomfort or bother associated with a monthly bleed, especially those who experience heavy periods.Adolescents involved in sports, or young adolescents who get their periods well before their peers and may want to stop their bleeds for a while, Dr. Adeyemi-Fowode says.Transgender people who menstruate may also desire this approach.
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“Menstruating can be an area of significant dysphoria, which can lead to distress and thoughts and behaviors of self-harm,” Dr. Stambough says.
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“In my patients who elect to use a method to suppress periods, there is a significant benefit to their mental health.”People with physical or cognitive disabilities “Patients with cognitive delay may have trouble comprehending menstruation or may face challenges maintaining personal hygiene during menstruation,” the report notes.Members of the military stationed in war zones or in other hazardous locations may want to stop their periods during this time.People in prison as well as people experiencing homelessness, who may not be able to easily access menstrual products or who have privacy concerns. Hormonal Therapy for Period Suppression Is Safe
Studies over the years have shown that period suppression is safe, the report states. “Obstetrician-gynecologists can reassure patients and caregivers that hormonal methods used to suppress menses do not affect future fertility and do not increase the risk of cancer.
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In fact, continuous use of combined oral contraceptive pills (OCPs) decreases the risk of certain cancers,” it says. “This [conclusion] is based on a substantial body of evidence,” Stambough says. Although some patients still harbor concerns that taking hormones continuously might cause a malignancy or other serious health problems, this hasn’t been borne out in research, she says.
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For example, one large study, published in the journal Contraception, compared women who took continuous birth control pills with those on the more traditional three-week-on, one-week-off protocol. Skipping the bleed week did not result in more adverse events during the year they were studied. “The bleed is not necessary,” Adeyemi-Fowode says, even though many people think it is because for years oral contraceptives included a placebo week when bleeding occurs.
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This was done so people would feel more comfortable using the medication when OCs were first introduced, she says. Periods Can Safely Be Suppressed in Adolescents
Gynecologists sometimes express concern that periods should not be suppressed in adolescents, because their bodies are still developing, she notes.
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But the report emphasizes that once a person has gotten their first period — but not before — they can safely receive hormonal medications. Adeyemi-Fowode admits the report authors were not able to find much research specifically in this age population (true for many other treatments as well).
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But she says there is no biological reason why hormones act differently in someone just getting their period compared with a person who has had it for years. Working with an adolescent patient (and their parents) may require more consideration about compliance, the report states, including how easy a method might be to use and to remember.
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Numerous Methods Are Available to Suppress Menstruation
A large portion of the report is dedicated to reviewing various treatment options for suppressing menstruation, including the pros and cons for each. For example, people can take daily oral contraceptives continually without that week of placebo pills.
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The advantage of this method is its long history of use. Disadvantages are that people must take the pill daily, and that it can take a number of cycles before bleeding completely stops, according to the guidance. Hormonal patches, applied weekly, have easier compliance.
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But there is less data on continuous usage. Depo medroxyprogesterone acetate (aka Depo) is a shot given just once every three months. But it may cause weight gain and has a temporary effect on bone density.
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Progestin-containing intrauterine devices (IUDs) need to be inserted (at considerable discomfort and often cost) once in seven years. But some bleeding continues in roughly half of recipients throughout the first year. Other methods described in the report include vaginal rings, hormone implants, oral progestins, and gonadotropin-releasing hormone antagonists.
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“There are certain formulations that need to be used with caution,” the Mayo Clinic’s Dr. Carrubba says, pointing especially to the loss of bone mineral density when using depo medroxyprogesterone or gonadotrophin-releasing hormone analogues. “Providers should carefully counsel patients about these risks, and reevaluate the safety profile periodically over the course of treatment,” she says.
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All These Suppression Methods Are Reversible
The decision to stop menstruation is made easier for many patients by the fact that all these methods are reversible, Stambough says. When the hormones are stopped, periods eventually resume, says David Ghadisha, MD, the regional director of obstetrics and gynecology for MedStar Health in Baltimore, who was not involved with the ACOG guidance report.
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Hormonal therapies do have side effects, though, he says, so the decision to suppress menstruation should not be made lightly. “The risk and benefit of the medications in the short- and long-term should be discussed with each patient,” Dr. Ghadisha says.
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No Method Perfectly Suppresses Menstruation
The goal of menstrual suppression is to decrease the amount of menstruation rather than guarantee it disappears altogether. “It’s not perfect for some patients, in terms of translating to no bleeding.
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Breakthrough bleeding occurs in some cases,” Stambough says. In the Contraception study, for example, some 30 percent of women on the continuous pills reported some bleeding or spotting in the first seven months, and 20 percent still had some even after a year. Decisions About Period Suppression Should Be Made Freely and Jointly
Doctors should counsel patients based on each person’s needs and goals, the report states.
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It goes on to state that this “should be approached with the utmost respect for patient autonomy and be free of coercion.”
Decision-making should be shared between the physician and the patient without bias, Stambough insists. Doctors need to respect their patients’ desires, but patients also need to be realistic about how much suppression each method can achieve, she says. The Patient s Preference Matters Most
Should a patient find their doctor is not supportive of their goals, they should seek out one who is, Stambough says.
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“Whether they have a medical indication or the patient desires it — and that’s enough of a reason — they should be able to talk to a provider who is open and willing to hear their concerns and allows them to make the best decisions based on their health status and whichever methods would be safe and effective for them,” she says. NEWSLETTERS
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