Position StatementsMenstrual Suppression (2003)
Developed at: Menstrual Suppression Panel
SMCR 15th Biennial Conference, Pittsburgh, PA, June 5-7, 2003
In an effort to raise awareness about menstrual suppression and initiate dialogue among women’s health practitioners and scholars of the menstrual cycle, a panel was recently delivered on June 6th, 2003 at the 15th Biennial Meeting of the Society for Menstrual Cycle Research in Pittsburgh, PA. The panel consisted of three papers, addressing menstrual suppression from multiple perspectives.
Authors of the first paper, Christine Hitchcock and Jerilyn Prior, reviewed studies that have been published on extending the schedule of oral contraceptive pills in order to reduce the frequency of menstrual bleeding. They concluded that we do not yet have evidence to suggest that menstrual suppression is entirely safe and reversible. The second set of authors, Alex Hoyt and Linda Andrist presented results from a study of women’s attitudes toward menstrual suppression. They concluded that negative attitudes toward the menstrual cycle were a better predictor of women’s interest in menstrual suppression than women’s menstrual symptoms, suggesting the importance of psychosocial factors in women’s decision making about altering their menstruation. The third paper, by Ingrid Johnston-Robledo and Jessica Barnack, addressed popular media coverage of menstrual suppression. From their analysis of print media, they concluded that regular menstruation is presented as bothersome and even unhealthy. Advocates of menstrual suppression and its benefits were afforded more space than opponents and risks. As with many other health issues, women are not getting accurate, balanced information, rendering an informed decision about this health care option difficult if not impossible.
The notion that monthly menstruation is no longer considered a necessary, healthy process, particularly for women who experience endometriosis and severe PMS, was popularized after the publication of the book, Is Menstruation Obsolete by Elsimar Coutinho and Sheldon Segal in 1999. Women can essentially avoid or suppress frequent menstruation by taking a standard oral contraceptive continuously without the 7-day placebo pills. The typical recommendation is that women take this regimen of pills for three months and then experience a pill-free week such that they menstruate every three months. Another birth control pill, Seasonale, is specifically designed to suppress menstruation, although it is not yet approved by the FDA. Women using this oral contraceptive will be on a schedule of active pills for 84 days and then take placebo pills for 7 days. Menstrual suppression was originally recommended for women with disorders related to the menstrual cycle such as endometriosis, but is now being recommended to and practiced by women without such disorders.
Members of the Society for Menstrual Cycle Research have a range of opinions about this complicated and controversial issue. What we do
agree on, however, is that:
1) More research is needed before women can make informed decisions.
Women and health care providers need to know more about the reasons why people choose menstrual suppression, and the medical consequences of making that choice. We need psychosocial research looking at women’s attitudes, concerns, preferences, and needs for information. We need well-designed, randomized, placebo-controlled trials of long-term oral contraceptive use for menstrual suppression, examining women’s experiences, bone health, and risks for blood clots and strokes. These studies should include women who are not taking any oral contraceptives, and not just compare women on different schedules of active pills. We also need studies to assess the recovery of fertility following discontinuation.
2) While we recognize that menstrual suppression may be a useful option for women with severe menstrual cycle problems such as endometriosis, we do not believe that continuous oral contraceptive use should be prescribed to all menstruating women out of a rejection of a normal, healthy menstrual cycle. We are particularly concerned about the potential effects of extended oral contraceptive use on adolescents, given their vulnerability during development and the absence of data regarding the safety of this practice for this age group.