Menstrual suppression

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Chapter 7
Menstrual suppression

Chapter 7 – Abnormal Uterine Bleeding and Other Disorders of the Menstrual Cycle

Topic

The menstrual cycle: An introduction
Menstrual abnormalities
Abnormal uterine bleeding
Premenstrual syndrome (PMS)
Menstrual suppression
Menstrual disorders in adolescents
Congenital anomalies of the genital tract
Resources
- Additional reading
References

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Requests to delay a menstrual period

Requests to delay or skip a menstrual period because of an important event are common. Ideally there is sufficient time to be able to advise at least 3 weeks of a combined hormonal contraceptive method (a pill or vaginal ring) for those who are medically eligible following which the hormone-free break can be skipped in order to avert a withdrawal bleed. Alternatively, 1 tablet norethisterone 5mg (Primolut N) 2 to 3 times daily for up to 10 -14 days, beginning about 3 days before the expected menstruation can be used. Bleeding will occur 2 – 3 days after having stopped medication. Note that due to the partial conversion of norethisterone to ethinyloestradiol, administration of Primolut N is expected to result in similar pharmacological effects as seen with COCs including an elevated risk of venous thromboembolism and should therefore not be used in women with pre-existing VTE risk factors.

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Dickerson E, Raghunath AS, Atkin SL. Rational testing: initial investigation of amenorrhoea. BMJ. 2009;339:b2184.

Wellman M. Investigating primary and secondary amenorrhoea. Medicine Today. 2015;16(11):27-32.

Teede H, Misso M, Costello M, Dokras A, Laven J, Moran L. International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. Melbourne, Victoria: Monash University; 2018. Available from: https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf.

Practice Committee of the American Society for Reproductive Medicine. Current evaluation of amenorrhea. Fertil Steril. 2008;90(suppl 5):S219-25.

Pitts M, Ferris JA, Smith AMA, Shelley JM, Richters J. Prevalence and correlates of three types of pelvic pain in a nationally representative sample of Australian women. MJA. 2008;189(3):138-43.

Reddish S. Dysmenorrhoea. Aust Fam Physician. 2006;35(11):846-9.

National Institute for Health and Care Excellence (NICE). Endometriosis: diagnosis and management. NG73. NICE; 2017. Available from: https://www.nice.org.uk/guidance/ng73.

European Society of Human Reproduction and Embryology. ESHRE guideline for the diagnosis and treatment of endometriosis. ESHRE; 2007 [updated 2007 June 30]. Available from: http://guidelines.endometriosis.org/introduction.html.

European society of Human Reproduction and Embryology (ESHRE) Endometriosis Guideline Development Group. Management of women with endometriosis. ESHRE; 2013. Available from: https://www.eshre.eu/Guidelines-and-Legal/Guidelines/Endometriosis-guideline.aspx.

10.

Petraglia F, Hornung D, Seitz C, Faustmann T, Gerlinger C, Luisi S, et al. Reduced pelvic pain in women with endometriosis: efficacy of long-term dienogest treatment. Arch Gynecol Obstet. 2012;285(1):167-73.

11.

Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F. Role of medical therapy in the management of adenomyosis. Fertility and Sterility. 2018;109(3):398-405.

12.

Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertility and Sterility. 2018;109(3):406-17.

13.

National Institute for Health and Care Excellence (NICE). Heavy Menstrual Bleeding: Assessment and Management. NG88. NICE; 2018 [updated 2018 Mar]. Available from: https://www.nice.org.uk/guidance/ng88.

14.

Munro M, Critchley HO, Fraser IS, FIGO Menstrual Disorders Working Group. The FIGO classification of causes of abnormal uterine bleeding in the reproductive years. Fertil Steril. 2011;95(7):2204-8.

15.

Munro M, Critchley HO, Broder MS, Fraser IS, FIGO Working Group of Menstrual Disorders. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age. Int J Gynaecol Obstet. 2011;113(1):3-13.

16.

Australian Commission on Safety and Quality in Healthcare (ACSQHC). Heavy Menstrual Bleeding Clinical Care Standard. Sydney: ACSQHC; 2017. Available from: https://www.safetyandquality.gov.au/standards/clinical-care-standards/heavy-menstrual-bleeding-clinical-care-standard.

17.

National Institute for Health and Care Excellence (NICE). Heavy Menstrual Bleeding: Assessment and Management. NG88. NICE; 2007 [updated: 2016 Aug].

18.

Bateson D, Black K. Heavy menstrual bleeding: Treatment and referral options. Medicine Today. 2018;19(5):27-32.

19.

Dickerson K, Menon N, Zia A. Abnormal uterine bleeding in young women with blood disorders. Pediatr Clin North Am. 2018;65(3):543-60.

20.

Department of Health. Understanding the National Cervical Screening Program Management Pathway: A Guide for Healthcare Providers. Australian Government; 2017 [updated 2019 Nov 27]. Available from: https://www.health.gov.au/resources/publications/national-cervical-screening-program-understanding-the-national-cervical-screening-program-management-pathway.

21.

Jensen J, Parke S, Mellinger U, Machlitt A, Fraser IS. Effective treatment of heavy menstrual bleeding with estradiol valerate and dienogest: a randomized controlled trial. Obstet Gynecol. 2011;117(4):777-87.

22.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College statement C-Gyn 23: Uterine artery embolisation for the treatment of uterine fibroids. [Internet]. RANZCOG; 2008 [updated 2014]. Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/Uterine-Artery-Embolisation-(C-Gyn-23)_2.pdf?ext=.pdf.

23.

Uterine Cancer [internet]. Cancer Council; 2019 [updated 2019 Mar 29]. Available from: https://www.cancer.org.au/about-cancer/types-of-cancer/uterine-cancer.html.

24.

Abnormal Vaginal Bleeding in Pre- and Peri-Menopausal Women: A Diagnostic Guide for General Practitioners Gynaecologists [internet]. The Royal Australian and New Zealand College of Radiologists, Cancer Australia, National Centre for Gynaecological Cancers: Australian Government; 2011. Available from: https://www.canceraustralia.gov.au/publications-and-resources/cancer-australia-publications/abnormal-vaginal-bleeding-pre-peri-and-post-menopausal-women-diagnostic-guide-general-practitioners.

25.

McPherson K, Metcalfe MA, Herbert A, Maresh M, Casbard A, Hargreaves J, et al. Sever complications of hysterectomy: the VALUE study. BJOG: an International Journal of Obstetrics and Gynaecology. 2004;111:688-94.

26.

Ely J, Kennedy CM, Clark EC, Bowdler NC. Abnormal Uterine Bleeding: A Management Algorithm. J Am Board Fam Med. 2006;19(6):590-602.

27.

Read C, May T, Stellingwerff M. How to Treat: Irregular Vaginal Bleeding Australian Doctor 2007;18(May):27 -34.

28.

Selo-Ojeme D, Dayoubi N, Patel A, Metha M. A clinico-pathological study of post coital bleeding. Arch Gynecol and Obstet. 2004;270:34-6.

29.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College statement C-Gyn 6: Investigation of intermenstrual and postcoital bleeding. [Internet]. RANZCOG; 1995 [reviewed 2015 Mar].

30.

Bateson B, Brand A, Hammond I, Mountford J, Whop L, Cancer Council Australia Cervical Cancer Screening Guidelines Working Party. Signs and symptoms of cervical cancer – identification and investigation of abnormal bleeding. [Internet]. 2019. Available from: https://wiki.cancer.org.au/australia/Clinical_question:Investigation_of_abnormal_vaginal_bleeding.

31.

Goldacre M, Loudon N, Watt B, Grant G, Loudon JD, McPherson K, et al. Epidemiology and clinical significance of cervical erosion in women attending a family planning clinic. Br Med J. 1978;1(6115):748-50.

32.

National Institute for Health and Care Excellence (NICE). Suspected cancer: recognition and referral. Blood and immune system conditions. NG12. [Internet]. NICE; 2015 [updated: 2017 Jul]. Available from: https://www.nice.org.uk/guidance/ng12.

33.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-V). 5th ed. Washington DC: APA; 2013.

34.

Tamoxifen and Uterine Cancer [internet]. The American College of Obstetricians and Gynecologists (ACOG); 2014 [updated 2020]. Available from: https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Gynecologic-Practice/Tamoxifen-and-Uterine-Cancer?IsMobileSet=false.

35.

Green L, O’Brien PMS, Panay N, Craig M on behalf of the Royal College of Obstetricians and Gynaecologists. Management of premenstrual syndrome. BJOG. 2017;124:e73-e105.

36.

Backstrom T, Heineman K, Nyberg S, Hammarback S. Definition and prevalence of premenstrual syndrome. Gynaecology Forum. 2009;14:14-7.

37.

Pearlstein T, Bachmann GA, Zacur HA, Yonkers KA. Treatment of premenstrual dysphoric disorder with a new drospirenone-containing oral contraceptive formulation. Contraception. 2005;72(6):414-21.

38.

Van Die M, Burger HG, Teede HJ, Bone KM. Vitex agnus-castus extracts for female reproductive disorders: a systematic review of clinical trials. Planta Med. 2013;79:562-75.

39.

Schellenberg R. Treatment for the premenstrual syndrome with agnus castus fruit extract: prospective, randomised, placebo controlled study. BMJ. 2001;322(7279):134-7.

40.

Thys-Jacobs S, Starkey P, Bernstein D, Tian J. Calcium carbonate and the premenstrual syndrome: effects on premenstrual and menstrual symptoms. Am J Obstet Gynecol. 1998;179(2):442-52.

41.

Brown J, O’Brien PM, Marjoribanks J, Wyatt K. Selective serotonin reuptake inhibitors for premenstrual syndrome. Cochrane Database Syst Rev. 2009;Apr 15(2):CD001396.

42.

Green L, O’Brien PMS, Panay N, Craig M on behalf of the Royal College of Obstetricians and Gynaecologists. Green-Top Guideline No. 48: Management of Premenstrual Syndrome. BJOG. 2017;124:e73-e105.

43.

eTG Complete. Therapeutic Guidelines; 2019. Premenstrual Syndrome.

44.

Whelan A, Jurgens TM, Naylor H. Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Can J Clin Pharmacol. 2009;16(3):e407-e29.

45.

Wyatt K, Dimmock PW, Jones PW, Shaughn O’Brien PM. Efficacy of vitamin B-6 in the treatment of premenstrual syndrome: systematic review. BMJ. 1999;22(318).

46.

Quint E, O’Brien RF, AAP the Committee on Adolescence, AAP the North American Society for Pediatric and Adolescent Gynecology. Menstrual Management for Adolescents With Disabilities. Pediatrics. 2016;137(4):e20160295.

47.

Kirkman Y, Ornstein M, Aggarwal A, McQuillan S. Menstrual Suppression in Special Circumstances. JOGC. 2019;41(2):e7-e17.

48.

Wilbur J, Torondel B, Hameed S, Mahon T, Kuper H. Systematic review of menstrual hygiene management requirements, its barriers and strategies for disabled people. PLoS ONE. 2019;14(2):e210974.

49.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG). College Statement C-Gyn-10: Fertility and menstrual management in women with an intellectual disability. [Internet]. RANZCOG; 1997 (reviewed: 2016 Mar). Available from: https://ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women%27s%20Health/Statement%20and%20guidelines/Clinical%20-%20Gynaecology/Fertility-and-menstrual-management-in-women-with-an-intellectual-disability-(C-Gyn-10)-Review-July-2016_1.pdf?ext=.pdf.

50.

Williams C, Creighton S. Menstrual Disorders in Adolescents: Review of current practice. Horm Res Paediatr. 2012;78:135-43.

51.

Mooed S, Mellor A. Dysmenorrhoea in Adolescents. O&G Magazine. 2017;19(3).

52.

Velayuthum V, Dahiya R. Disorders of pubertal timing in young people. Medicine Today. 2017;18(5):24-32.

53.

Abitbol L, Zborovski S, Palmert M. Evaluation of delayed puberty: what diagnostic tests should be performed in the seemingly otherwise well adolescent? Arch Dis Child. 2016;101:767-71.

54.

Matthews K, Benny P. Uterine and related structural anomalies. O&G Magazine. 2010;12(3).

55.

Short A. Congenital anomalies of the female genital tract. O&G Magazine. 2017;19(3).

56.

Dietrich J, Millar DM, Quint EH. Non-obstructive Müllerian Anomalies. Journal of Pediatric and Adolescent Gynecology. 2014;27:386-95.

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