Many women are becoming interested in reducing or eliminating their periods.¹ For example, sizeable numbers of women in the international amenorrhea acceptability study,² the German study,³ the Association of Reproductive Health Professionals’ (ARHP) Menstrual Suppression Survey,⁴ and the women interviewed through the Harris poll in 2002⁵ preferred to menstruate less than once a month or never. According to research by Sulak and colleagues,⁶ Miller and Notter,⁷ and Anderson and colleagues,⁸¹ many women who try an extended regimen choose to continue with it.

Providers are also recognizing the benefit of extended and continuous contraception. Of 117 ARHP and National Association of Nurse Practitioners in Women’s Health meeting registrants who were surveyed, 77 percent said they prescribed extended contraceptives.⁹ In ARHP’s Menstrual Suppression Survey, half of providers surveyed said they prescribed extended contraception, many upon patient request.4 In the American College of Obstetricians and Gynecologists’ survey of female obstetrician/gynecologists, 99 percent believed that menstrual suppression is safe and over half had suppressed their own periods.¹⁰

Yet numerous barriers to menstrual suppression remain. The release of Seasonale^®—a dedicated product for extended contraceptive use—in 2003 has raised awareness of menstrual suppression among clinicians and women. However, it is also essential to provide ongoing education of health care providers and women about extended contraceptives and to create counseling tools for providers. Recommendations include the following.

Educate providers about menstrual suppression:

• Benefits and effects of regulating menstruation
• Surveys on women’s attitudes and beliefs about menstruation and its suppression
• Various hormonal therapies to adjust menstruation and related research
• Different cultural values and beliefs about menstruation

Improve patient counseling:

• Explaining the female reproductive system and the effect of extended regimen contraception on the system
• Addressing myths about the need to menstruate during use of hormonal contraception
• Developing better counseling tools for providers
• Describing the endometrial safety of extended use of combination hormone therapy

Increase the awareness and knowledge of women about extended regimen contraception through provider counseling and media venues:

• No need to menstruate while on hormonal contraception
• Ways to change menstruation
• Health and lifestyle advantages to suppressing menstruation
• Research findings on health effects of extended contraceptive methods

Conduct further research to answer questions:

Extended and Continuous Regimen Methods

• What patterns of bleeding can women expect with extended or continuous use over time?
• Are there differences in bleeding patterns between new oral contraceptive (OC) extended or continuous regimen users and users who are switching from a traditional regimen to an extended or continuous regimen?
• What strategies might reduce or eliminate spotting and irregular bleeding during the early cycles of extended or continuous use contraceptives?
• What are the safety issues and noncontraceptive benefits associated with use of extended or continuous contraceptives?

Counseling

• How can health care providers counsel women to improve consistent use of OCs?
• What are the cultural differences in how women and families view menstruation?
• How do women feel about spotting with extended or continuous regimens?

Facilitating an Extended Regimen

• How can providers best integrate the use of extended regimen contraception into their practices?
• How can pills be packaged to make them easier to take?
• How can the cost of extended OC regimens be reduced?

Women should be able to choose whether and how to suppress their menstrual cycles. To enable them to choose, they and their providers need to be knowledgeable about the benefits and risks of various extended contraceptive regimens. Providing women with this choice has the potential to improve not only their reproductive health, but also the quality of life during their reproductive years.

References

1. Association of Reproductive Health Professionals. Continuous use of oral contraceptives. A supplement to The Female Patient^®, April 2002.

2. Glasier AF, Smith KB, van der Spuy AM, et al. Amenorrhea associated with contraception—an international study on acceptability. Contraception 2003;67:1-8.

3. Wiegratz I, Hommel HH, Zimmermann T, Kuhl H. Attitude of German women and gynecologists towards long-cycle treatment with oral contraceptives. Contraception 2004;69:37-42.

4. Andrist LC, Arias RD, Nucatola D, et al. Women’s and providers’ attitudes toward menstrual suppression. Contraception; in press.

5. Association of Reproductive Health Professionals. Extended regimen oral contraceptives. Harris Poll, June 14-17, 2002.

6. Sulak PJ, Kuehl TJ, Ortiz M, Shull BL. Acceptance of altering the standard 21-day/7-day oral contraceptive regimen to delay menses and reduce hormone withdrawal symptoms. Am J Obstet Gynecol 2002;186:1142-1149.

7. Miller L, Notter KM. Menstrual reduction with extended use of combination oral contraceptive pills: randomized controlled trial. Obstet Gynecol 2001;98(5 Pt 1):771-778.

8. Anderson FD, Hait H, Seasonale-301 Study Group. A multicenter, randomized study of an extended cycle oral contraceptive. Contraception 2003;68:89-96.

9. Association of Reproductive Health Professionals and National Association of Nurse Practitioners in Women’s Health. Annual meeting registrant survey. August-September 2002.

10. American College of Obstetricians and Gynecologists. Gallup survey reveals women ob-gyns benefit from “insider knowledge.” ACOG news release, December 9, 2003. Available at: http://www.acog.org/from_home/publications/press_releases/nr12-09-03-2.cfm. Retrieved August 15, 2004.