Menstruation on hold? More women favor option
Ask your next patient if she would like to reduce the number of bleeding days requiring sanitary protection as well as lessen such troublesome symptoms as bloating and cramps. Chances are that she will say "yes."
"Interest continues to grow among clinicians and women regarding using hormones to reduce menstruation," says Andrew Kaunitz, MD, professor and assistant chair in the obstetrics and gynecology department at the University of Florida Health Science Center/Jacksonville.
While surveys conducted in the 1970s and 1980s suggested that amenorrhea was unacceptable to most women, more recent research indicates that more women prefer to menstruate less often.1 Scientists recently conducted an international survey to explore women’s willingness to use a contraceptive that induces amenorrhea.1
The study, which analyzed responses from a questionnaire survey of 1,001 women attending family planning clinics and 290 contraceptive providers in China, South Africa, Nigeria, and Scotland, found that most women disliked periods, which they termed "inconvenient."1 Only among black women in Africa did the majority like having periods. Given the choice, the majority of Nigerian women said they would prefer to bleed monthly; elsewhere, women said they would opt to bleed only once every three months, or not at all. The Nigerian women said they liked having periods to "get rid of bad blood" and to reassure themselves that they were not pregnant. The majority of women surveyed said they would be willing to try a contraceptive that induces amenorrhea.
Reduced bloating and menstrual pain may be desirable options for women who choose continuous oral contraceptive (OC) dosing regimens, according to another recent study.2 Scientists compared bleeding patterns and acceptability of a contraceptive regimen of a combined 20-mcg ethinyl estradiol/100-mcg levonorgestrel pill from Wyeth Pharmaceuticals of Collegetown, PA, taken with and without a hormone-free interval.2 In this small study, women were randomized to six conventional cycles (21 days of active tablets followed by seven hormone-free days) or 168 continuous days of active tablets. Outcomes assessed included bleeding (flow requiring sanitary protection), spotting (no protection), headache, nausea, bloating, breast tenderness, premenstrual syndrome, and menstrual pain.
Although both groups reported a high level of satisfaction with bleeding patterns and side-effect profiles, women in the continuous group reported significantly fewer days of bloating and menstrual pain.
Examine the options
Women have options outside extended use of combined OCs when it comes to safe, effective birth control with reduced uterine bleeding, says Kaunitz. These include the Depo-Provera contraceptive injection (depot medroxyprogesterone acetate, Pharmacia Corp., Peapack, NJ) and the Mirena levonorgestrel intrauterine system (Berlex Laboratories, Montville, NJ). Researchers also are looking at extended use of the contraceptive patch (Evra, Ortho McNeil Pharmaceuticals, Raritan, NJ) and ring (NuvaRing, Organon, West Orange, NJ) as potential candidates for reducing menstruation.
According to A Pocket Guide to Managing Contraception, women whose quality of life would be improved by reducing the frequency of or eliminating menses with continuous OC use may include women who are on military assignment or women with cyclic depression, headaches, or premenstrual syndrome.3 Use monophasic pills when prescribing a continuous-use regimen, it suggests.
Seasonale under review
An oral contraceptive with a regimen specifically designed to put menstruation on hold is under evaluation by the Food and Drug Administration (FDA) The agency accepted Pomona, NY-based Barr Laboratories’ New Drug Application for its proprietary pill, Seasonale, in August 2002; the company continues to work with the FDA on the application, say company officials. Barr Laboratories, in agreement with the Medical College of Hampton Roads, Eastern Virginia Medical School in Norfolk, VA, are developing the pill.
The Seasonale regimen is designed to reduce the number of withdrawal bleeds from 13 to four per year. Under its regimen, women take the OC for up to 84 consecutive days, followed by seven days of placebo. This pill-taking regimen contrasts with the majority of oral contraceptives, which are based on a regimen of 21 treatment days, followed by seven days of placebo.
In a multicenter trial, two versions of the Seasonale extended oral contraceptive therapy prevented pregnancy comparable to study drugs.4 The adverse profile of the Seasonale drug was similar to that of other oral contraceptives, study findings indicate.
References
1. Glasier AF, Smith KB, van der Spuy ZM, et al. Amenorrhea associated with contraception — an international study on acceptability. Contraception 2003; 67:1-8.
2. Kwiecien M, Edelman A, Nichols MD, et al. Bleeding patterns and patient acceptability of standard or continuous doing regimens of a low-dose oral contraceptive: A randomized trial. Contraception 2003; 67:9-13.
3. Hatcher RA, Nelson AL, Zieman M, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation; 2001.
4. Anderson FD, The safety and efficacy of Seasonale, a novel 91-day extended oral contraceptive regimen. Obstet Gynecol 2002, 99:26S.
Scientists recently conducted an international survey to explore womens willingness to use a contraceptive that induces amenorrhea.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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