Menstrual Suppression: Coming of Age?
With the assistance of their clinicians, women have been adjusting
their menstrual cycles for years—to avoid bleeding while on their
honeymoon, during an athletic event, or to find relief from dysmenorrhea—usually
by eliminating the hormone-free week in an oral contraceptive (OC) regimen.
Health care providers have also helped women to reduce or eliminate
menstruation in the treatment of endometriosis, migraines, and other
medical conditions by prescribing the extended use of OCs or depot medroxyprogesterone
acetate (DMPA) injections.
In September 2003, a dedicated extended OC regimen, Seasonale®,
was approved by the US Food and Drug Administration (FDA), bringing
the concept of menstrual suppression into the mainstream. A number of
similar products are being developed or are in clinical trials. This
trend is helping to increase the acceptance and popularity of the extended
use of OCs among women, health care providers, and third-party payers.
Other contraceptive methods for extended use are also available, including
DMPA injections (Depo-Provera®)
and the progestin-releasing intrauterine system (Mirena®).
Still others are being studied, including extended use of the vaginal
contraceptive ring (NuvaRing®)
and the contraceptive patch (Ortho Evra®).
Approval by the FDA of a single-rod contraceptive implant (Implanon™)
would make yet another extended hormonal method available to American
women. Different schedules are being investigated as well, including
extended regimens (where use of the contraceptive is periodically interrupted
for a withdrawal bleed) and continuous regimens.
The topic of extended regimen contraception was first reviewed by
the Association of Reproductive Health Professionals (ARHP) and the
National Association of
Nurse Practitioners in Women’s Health (NPWH) in an issue of
Clinical Proceedings®
published in April 2003. The current issue provides an update on the
subject of the role of extended regimen contraception in light of the
release of the dedicated extended regimen OC. It also reviews studies
and surveys on the attitudes and practices of health care providers
and women concerning the extended use of contraceptives, as well as
recent research on extended use of various contraceptive methods. Because
counseling represents a key element in women’s acceptance and
proper use of extended regimens, this monograph also provides educational
tools for health care providers to use in counseling their patients.
Extended regimen contraception gives women another reproductive health
choice—when and whether to experience menstrual bleeding. We are
pleased to help advance the research and practice of extended regimen
contraception through this issue of Clinical Proceedings.
Wayne C. Shields
ARHP President and CEO
Susan Wysocki, RNC, NP
NPWH President and CEO
Learning Objectives
After completing this Clinical Proceedings, participants will be able
to:
- Describe three examples of the impact of menstruation on lifestyle,
productivity, and medical conditions.
- Name four approaches to prescribing extended hormonal contraception.
- Name five noncontraceptive health advantages of medically suppressing
menstruation.
- Cite two clinical trials that provide data on the endometrial safety
of extended regimens of oral contraception.
- List three obstacles to extended contraceptive regimens and state
two recommended approaches to patient counseling.
ARHP Clinical Proceedings®
is a publication of the Association of Reproductive Health Professionals
(ARHP). The publishers reserve copyright on all published materials,
and such material may not be reproduced in any form without the written
permission of ARHP.
This publication is intended for physicians, nurse practitioners,
nurse midwives, registered nurses, pharmacists, physician assistants,
researchers, public health professionals, and health educators in the
field of reproductive health.
ARHP is a non-profit, 501(c)(3) educational organization with a membership
of obstetrician/gynecologists and other physicians, advanced practice
clinicians, researchers, educators, and other professionals in reproductive
health.
Please direct all inquiries to:
ARHP
2401 Pennsylvania Avenue, NW, Suite 350
Washington, DC 20037-1730 USA
Phone: (202) 466-3825 • Fax: (202) 466-3826
E-mail: arhp@arhp.org • Web:
www.arhp.org
Accreditation
Physicians—ARHP is accredited by the Accreditation
Council for Continuing Medical Education (ACCME) to sponsor continuing
medical education (CME) for physicians. ARHP designates this continuing
medical education activity for 2 credit hours in Category 1 of the Physician’s
Recognition Award of the American Medical Association.
Nurses and Nurse Practitioners—This educational
activity has been approved by the Continuing Education Approval Program
of the National Association of Nurse Practitioners in Women’s
Health (NPWH) for 2.4 contact hours, including 0.8 pharmacology hours.
Credit can be applied toward the nursing continuing education requirements
of most professional organizations and State Boards of Nursing.
Nurse Midwives—ACCME credit hours in Category
One are accepted by the Continuing Competency Assessment Program of
the American College of Nurse Midwives (ACNM) for programs relevant
to nurse midwifery. Nurse Midwives completing this activity may report
up to 2 hours of credit.
Physician Assistants—The American Academy of
Physician Assistants accepts Category One CME approval from organizations
accredited by the ACCME. Physician Assistants completing this activity
may report up to 2 hours of credit.
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