Abstract
Objective
To provide a Canadian consensus document for health care providers with recommendations
for menstrual suppression in patients with physical and/or cognitive challenges or
those who are undergoing cancer treatment in whom menstruation may have a deleterious
effect on their health.
Options
This document reviews the options available for menstrual suppression, its specific
indications, contraindications, and side effects, both immediate and long-term, and
the investigations and monitoring necessary throughout suppression.
Outcomes
Clinicians will be better informed about the options and indications for menstrual
suppression in patients with cognitive and/or physical disabilities and patients undergoing
chemotherapy, radiation, or other treatments for cancer.
Evidence
Published literature was retrieved through searches of Medline, EMBASE, OVID, and
the Cochrane Library using appropriate controlled vocabulary and key words (heavy
menstrual bleeding, menstrual suppression, chemotherapy/radiation, cognitive disability,
physical disability, learning disability). Results were restricted to systematic reviews,
randomized controlled trials, observation studies, and pilot studies. There were no
language or date restrictions. Searches were updated on a regular basis and new material
was incorporated into the guideline until September 2013. Grey (unpublished) literature
was identified through searching websites of health technology assessment and health
technology-related agencies, clinical practice guideline collections, clinical trial
registries, and national and international medical specialty societies.
Values
The quality of evidence was rated using the criteria described in the Report of the
Canadian Task Force on Preventive Health Care (Table 1).
Benefits, harms, and costs
There is a need for specific guidelines on menstrual suppression in at-risk populations
for health care providers.
Recommendations
- 1Menstrual suppression and therapeutic amenorrhea should be considered safe and viable options for women who need or want to have fewer or no menses (II-2A).
- 2Menstrual suppression should not be initiated in young women with developmental disabilities until after the onset of menses (II-2B).
- 3Combined hormonal or progesterone-only products can be used in an extended or continuous manner to obtain menstrual suppression (I-A).
- 4Gynaecologic consultation should be considered prior to the initiation of treatment in all premenopausal women at risk for abnormal uterine bleeding from chemotherapy (II-1A).
- 5Leuprolide acetate or combined hormonal contraception should be considered highly effective in preventing abnormal uterine bleeding when initiated prior to cancer treatment in premenopausal women at risk for thrombocytopenia (II-2A).
Key Words
Abbreviations:
AUB (abnormal uterine bleeding), BMD (bone mineral density), CHC (combined hormonal contraception), DEXA (dual X-ray absorptiometry), DMPA (depot medroxyprogesterone acetate), GnRH (gonadotropin releasing hormone), IM (intramuscular), IUD (intrauterine device), IV (intravenous), LA (leuprolide acetate), LNG-IUS (levonorgestrel intrauterine system), OCP (oral contraceptive pill), POP (progestin-only pill)To read this article in full you will need to make a payment
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Article info
Publication history
No. 313, October 2014 (Reaffirmed February 2019)
Footnotes
This document reflects emerging clinical and scientific advances on the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Local institutions can dictate amendments to these opinions. They should be well documented if modified at the local level. None of these contents may be reproduced in any form without prior written permission of the publisher.
All people have the right and responsibility to make informed decisions about their care in partnership with their health care providers. In order to facilitate informed choice, patients should be provided with information and support that is evidence-based, culturally appropriate and tailored to their needs.
This guideline was written using language that places women at the centre of care. That said, the SOGC is committed to respecting the rights of all people – including transgender, gender non-binary, and intersex people – for whom the guideline may apply. We encourage healthcare providers to engage in respectful conversation with patients regarding their gender identity as a critical part of providing safe and appropriate care. The values, beliefs and individual needs of each patient and their family should be sought and the final decision about the care and treatment options chosen by the patient should be respected.
Identification
Copyright
Copyright © 2018 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc.
