The American College of Obstetricians and Gynecologists (ACOG) has released updated guidelines on the medical management of menstrual suppression, aiming to provide a comprehensive overview of available options, principles, and counseling approaches for individuals seeking to suppress their menstrual cycles. These guidelines are particularly beneficial for unique populations, including adolescents, those with physical or cognitive disabilities, and individuals with limited access to healthcare.

What is Menstrual Suppression?

Menstrual suppression involves the use of hormonal medications to reduce the frequency and volume of menstrual bleeding, and in some cases, achieve complete amenorrhea (absence of menstruation). The goal is to provide relief from heavy or painful periods, improve quality of life, and address specific medical or personal needs.

Benefits of Menstrual Suppression

• Heavy Menstrual Bleeding: Women experiencing heavy menstrual bleeding can benefit from menstrual suppression as it reduces blood loss and alleviates related symptoms such as anemia and severe cramps.
• Disabilities: For individuals with physical or cognitive disabilities, managing menstruation can be challenging. Menstrual suppression can simplify hygiene management and reduce caregiver burden.
• Military Deployment: Menstrual suppression is particularly beneficial for individuals in the military who may face challenges in maintaining menstrual hygiene in deployed or hazardous environments.
• Gender Dysphoria: Transgender and gender-diverse individuals who menstruate may experience significant distress. Menstrual suppression can help alleviate gender dysphoria associated with menstruation.
• Menstrual Cramps: Hormonal therapies used for menstrual suppression can also help manage and reduce the severity of menstrual cramps.

Methods of Menstrual Suppression

ACOG outlines various hormonal therapies for menstrual suppression, each with its own set of benefits and considerations:

• Combined Oral Contraceptive Pills (OCPs): These pills can be used continuously or in extended cycles to suppress menstruation. Continuous use is often preferred to prevent withdrawal bleeding and manage symptoms effectively.
• Contraceptive Patch: The patch is applied weekly and can be used in extended regimens to reduce menstrual bleeding. It is a good option for individuals who prefer less frequent administration.
• Vaginal Ring: This method involves inserting a ring that releases hormones, used continuously to suppress menstruation. Extended use of the vaginal ring has shown high rates of amenorrhea.
• Progestin-Only Pills: These pills, taken daily, cause endometrial atrophy and are effective for menstrual suppression, though they may result in irregular bleeding.
• Depot Medroxyprogesterone Acetate (DMPA): An injectable method given every three months, DMPA can result in high rates of amenorrhea with prolonged use but may have side effects such as weight gain and decreased bone density.
• Levonorgestrel-Releasing Intrauterine Device (LNG-IUD): This IUD releases hormones that thin the endometrial lining, leading to reduced menstrual bleeding. It is particularly effective for long-term use.
• Etonogestrel Implant: An implant inserted under the skin, releasing hormones for up to three years. It is effective for menstrual suppression but may cause irregular bleeding.

Counseling and Individualized Approaches

ACOG emphasizes the importance of individualized counseling when discussing menstrual suppression options. Clinicians should respect patient autonomy, address individual preferences and goals, and consider any contraindications or risk factors. Shared decision-making is crucial to ensure patients are fully informed about the benefits, limitations, and realistic expectations of each method.

Special Considerations

• Adolescents: Hormonal therapy for menstrual suppression is safe for adolescents once they have reached menarche. Counseling should include discussions on fertility, bone health, and the risk of sexually transmitted infections with non-barrier methods of contraception.
• Transgender and Gender-Diverse Patients: Menstrual suppression can help alleviate gender dysphoria. Testosterone therapy and other hormonal methods can be used to achieve amenorrhea, though they are not effective contraceptive methods.
• Patients with Disabilities: Menstrual suppression can be particularly beneficial for individuals with disabilities, helping to manage menstruation more easily and reducing caregiver burden.
• Drug Interactions: Clinicians should review all medications a patient is taking to avoid potential interactions with hormonal therapies used for menstrual suppression.
• Breakthrough Bleeding: One common issue with menstrual suppression is breakthrough bleeding. Proper counseling and management strategies can help address this and improve patient satisfaction.

Conclusion

Menstrual suppression offers significant benefits for a variety of individuals, improving quality of life and addressing specific medical needs. ACOG’s guidelines provide a thorough overview of the available options and emphasize the importance of individualized, respectful counseling to help patients make informed decisions about their reproductive health.