Benefits, harms, and costs
- 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).
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)
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Obstetrics and Gynaecology Canada
- ACOG Committee Opinion No. 448: Menstrual manipulation for adolescents with disabilities.Obstet Gynecol. 2009; 114: 1428-1431
- Society of Obstetricians and Gynaecologists of Canada. Canadian consensus guideline on continuous and extended hormonal contraception. SOGC Clinical Practice Guidelines, No. 195, July 2007.J Obstet Gynaecol Can. 2007; 29: S1-S32
- Society of Obstetricians and Gynecologists of Canada. Gynaecological and obstetric management of women with inherited bleeding disorders. SOGC Clinical Practice Guidelines, No. 163, July 2005.J Obstet Gynaecol Can. 2005; 27: 707-732
- Menstrual and contraceptive issues among young women with developmental delay: a retrospective review of cases at the Hospital for Sick Children, Toronto.J Pediatr Adolesc Gynecol. 2005; 18: 157-162
- The impact of menstruation in adolescents with disabilities related to cerebal palsy.Arch Dis Child. 2009; 95: 526-530
- Gynecologic issues of adolescents with Down syndrome, autism, and cerebral palsy.J Pediatr Adolesc Gynecol. 2010; 23: 11-15
- Suppression of menstruation in adolescents with severe learning disabilities.Arch Dis Child. 2007; 92: 629-632
- Trends in menstrual concerns and suppression in adolescents with developmental disabilities.J Adolesc Health. 2013; 53: 407-412
- Menstrual and contraceptive management in women with an intellectual disability.Med J Aust. 2002; 176: 108-110
- Management of menstrual problems and contraception in adolescents with mental retardation: a medical, legal, and ethical review with new suggested guidelines.J Pediatr Adolesc Gynecol. 2003; 16: 223-235
- Extended use of transdermal norelgestromin/EE: a randomized trial.Obstet Gynecol. 2005; 105: 1389-1396
- Extended regimens of the contraceptive vaginal ring: a randomized trial.Obstet Gynecol. 2005; 106: 473-482
- Postponement of withdrawal bleeding in women using low-dose combined oral contraceptives.Contraception. 1987; 35: 199-205
- Continuous versus cyclic use of combined oral contraceptives for contraception: systematic Cochrane review of randomized controlled trials.Hum Reprod. 2006; 21: 573-578
- Continuous, daily levonorgestrel/ethinyl estradiol vs. 21-day, cyclic levonorgestrel/ethinyl estradiol: efficacy, safety and bleeding in a randomized, open-label trial.Contraception. 2009; 80: 504-511
- Extended cycling or continuous use of hormonal contraceptives for female adolescents.Curr Opin Obstet Gynecol. 2009; 21: 407-411
- The use of hormonal contraception among women taking anticonvulsant therapy.Contraception. 2011; 83: 16-29
- Menstrual suppression for adolescents with developmental disabilities.J Pediatr Adolesc Gynecol. 2009; 22: 143-149
- Depot medroxyprogesterone acetate, oral contraceptives and bone mineral density in a cohort of adolescent girls.J Adolesc Health. 2004; 35: 434-441
- An evaluation of the use of the transdermal contraceptive patch in adolescents.J Adolesc Health. 2004; 34: 395-401
- Adolescents’ experience with the combined estrogen and progestin transdermal contraceptive method Ortho Evra.J Pediatr Adolesc Gynecol. 2005; 18: 85-90
- Contraceptive efficacy and cycle control with the Ortho Evra/Evra transdermal system: the analysis of pooled data.Fertil Steril. 2002; 77: S13-S18
- Frequency and management of breakthrough bleeding with continuous use of the transvaginal contraceptive ring: a randomized controlled trial.Obstet Gynecol. 2008; 112: 563-571
- Canadian contraception consensus. SOGC Clinical Practice Guidelines, No. 143: Part 2 of 3.J Obstet Gynaecol Can. 2004; 26: 219-254
- Menstrual issues in adolescents with physical and developmental disabilities.Ann N Y Acad Sci. 2008; 1135: 230-236
- Interactions between antiepileptic drugs and hormonal contraception.CNS Drugs. 2002; 16: 263-272
- Ad Hoc DMPA Committee of the Society of Obstetricians and Gynaecologists of Canada. Canadian Contraception Consensus— Update on Depot Medroxyprogesterone Acetate (DMPA). SOGC Clinical Practice Guidelines, No. 174, April 2006.J Obstet Gynaecol Can. 2006; 28: 305-313
- Antiepileptic drugs and hormonal contraceptives in adolescent women with epilepsy.Neurol. 2006; 66: S37-S45
- Effect of Depo-Provera or Microgynon on the painful crises of sickle cell anemia patients.Contraception. 1997; 56: 313-316
- Change in bone mineral density among adolescent women using and discontinuing depot medroxyprogesterone acetate contraception.Arch Pediatr Adolesc Med. 2005; 159: 139-144
- Bone density recovery after depot medroxyprogesterone acetate injectable contraception.Contraception. 2007; 77: 67-76
- Recovery of bone mineral density in adolescents following the use of depot medroxyprogesterone acetate contraceptive injections.Contraception. 2010; 81: 281-291
- Update on hormonal contraception and bone density.Rev Endocr Metab Disord. 2011; 12: 93-106https://doi.org/10.1007/s11154-011-9180-6
- Bone mineral density in healthy female adolescents according to age, bone age and pubertal breast stage.Open Orthop J. 2011; 5: 324-330
- Bone mineral density, fracture, and vitamin D in adolescents and young women using depot medroxyprogesterone acetate.J Pediatr Adolesc Gynecol. 2012; 25 (Epub 2011 Nov 12): 23-26
- Weight gain, adiposity, and eating behaviors among adolescent females on depot medroxyprogesterone acetate (DMPA).J Pediatr Adolesc Gynecol. 2004; 17: 109-115
- Contraceptive and therapeutic effects of the levonorgestrel intrauterine system: an overview.Obstet Gynecol Surv. 2005; 60: 604-612
- Levonorgestrel-releasing intrauterine device in the treatment of menorrhagia.Br J Obstet Gynaecol. 1990; 97: 690-694
- Bleeding patterns and clinical performance of the levonorgestrel- releasing intrauterine system (Mirena) up to two years.Contraception. 2002; 65: 129-132
- Levonorgestrel-releasing intrauterine system or medroxyprogesterone for heavy menstrual bleeding: a randomized controlled trial.Obstet Gynecol. 2010; 116: 625-632
- A nationwide cohort study of the use of the levonorgestrel intrauterine device in New Zealand adolescents.Contraception. 2009; 79: 433-438
- The use of Mirena IUS in adolescents: a review of the RCH experience.J Pediatr Adolesc Gynecol. 2010; 23: e83
- Revisiting the intrauterine contraceptive device in adolescents.J Pediatr Adolesc Gynecol. 2006; 19: 291-296
- The levonorgestrel IUS (Mirena) for the treatment of menstrual problems in adolescents with medical disorders or physical or learning disabilities.BJOG. 2010; 117: 216-221
- Menstrual suppression with the levonorgestrel intrauterine system in girls with developmental delay.J Pediatr Adolesc Gynecol. 2012; 25: 308-313
- Canadian Cancer Statistics 2011.Canadian Cancer Society, Toronto ON2011
- Prevention of severe menorrhagia in oncology patients with treatment- induced thrombocytopenia by luteinizing hormone-releasing hormone agonist and depo-medroxyprogesterone acetate.Cancer. 2006; 107: 1634-1641
- Prevention of hypermenorrhea with leuprolide in premenopausal women undergoing bone marrow transplantation.Am J Hematol. 1993; 42: 350-353
- Luteinizing hormone-releasing hormone analogue: leuprorelin acetate for the prevention of menstrual bleeding in premenopausal women undergoing stem cell transplantation.Bone Marrow Transplant. 1998; 21: 821-823
- Prevention of menstruation with leuprorelin (GnRH agonist) in women undergoing myelosuppressive chemotherapy or radiochemotherapy for hematological malignancies: a pilot study.Leuk Lymphoma. 2001; 42: 1033-1041
- Inducing amenorrhea during bone marrow transplantation. A pilot study of leuprolide acetate.J Reprod Med. 1997; 42: 537-541
- Prevention and treatment of uterine bleeding in hematologic malignancy.Eur J Obstet Gynecol Reprod Biol. 2007; 134: 3-8
- Management of menorrhagia associated with chemotherapy-induced thrombocytopenia in women with hematologic malignancy.Pharmacotherapy. 2011; 31: 1092-1110
- The management of menstrual suppression and uterine bleeding: a survey of current practices in the Pediatric Blood and Marrow Transplant Consortium.Pediatr Blood Cancer. 2012; 59 (Epub 2012 Feb 13): 553-557https://doi.org/10.1002/pbc.23360
- Gonadatrophin suppression to prevent chemotherapy- induced ovarian damage: a randomized controlled trial.Obstet Gynecol. 2013; 121: 78-86
- No protection of the ovarian follicle pool with the use of GnRH-analogues or oral contraceptives in young women treated with escalated BEACOPP for advanced-stage Hodgkin lymphoma. Final results of a phase II trial from the German Hodgkin Study Group.Ann Oncol. 2010; 21: 2052-2060
- Treatment of menorrhagia in women undergoing hematopoietic stem cell transplantation.Bone Marrow Transplant. 2004; 34: 363-366
- Treatment and prophylaxis of hypermenorrhea with leuprorelin in premenopausal women affected by acute leukemia at diagnosis.Am J Hematol. 1996; 51: 248-249
- Medical eligibility criteria for contraceptive use.4th ed. World Health Organization, Geneva2009
- Successful embolization for uterine hemorrhage in a patient with acute promyelocytic leukemia.Acta Haematol. 1983; 70: 199-221
- Near-fatal uterine hemorrhage during induction chemotherapy for acute myeloid leukemia: a case report of bilateral uterine artery embolization.Am J Hematol. 2004; 77: 151-155
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.