Menstrual manipulation: Options for suppressing the cycle

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Manipulation and suppression of menstruation through continuous or extended use of oral contraceptives or by other means may have a number of advantages to women, including fewer menstrual-related syndromes, reduced absenteeism from work or school, and greater overall satisfaction.

For women whose goal is to reduce but not necessarily to eliminate monthly bleeding, the cyclic use of estrogen-progestin contraception (rather than progestins alone or continuous use of combined hormonal preparations) is suggested.

For women whose goal is amenorrhea, depot medroxyprogesterone acetate injections, continuous oral contraceptives, and the levonorgestrel intrauterine device are all effective.67 Although randomized trials comparing these methods have not been done, depot medroxyprogesterone appears to have the highest rate of amenorrhea, while the levonorgestrel intrauterine device is the most convenient and appears to be associated with fewer bothersome side effects than progestin injection.68 Patients using depot medroxyprogesterone should have their bone density followed to detect and prevent bone loss, while users of estrogenprogestin pills, the transdermal patch, or the vaginal ring should not have any contraindications to the use of contraceptive doses of estrogen (Table 2).69

Clinicians should not overestimate the risks of oral contraceptives and other hormonal methods, but rather educate themselves so that they can utilize menstrual manipulation safely to match the individual patient’s needs.

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