Acceptability of contraceptive-induced amenorrhea in a racially diverse group of US women

doi:10.1016/j.contraception.2007.02.005

Contraception

Volume 75, Issue 6, June 2007, Pages 450-453

https://doi.org/10.1016/j.contraception.2007.02.005 Get rights and content

Abstract

Objective

The study was conducted to determine women's preferences about menstrual bleeding patterns and their willingness to manipulate bleeding with contraception.

Study Design

Women presenting for routine obstetric and gynecologic care at two US locations (Portland, OR, and Atlanta, GA) were offered a self-administered, anonymous survey. A validated survey tool was used.

Results

Valid surveys from 292 women were obtained. Mean age was 27 years (SD 8.0). We were unable to separate geographic vs. racial differences in responses because race significantly differed between sites (p<.001). The populations surveyed were predominately black in Georgia (88%, 58/66) and white in Oregon (83%, 142/172). Overall, the majority of women did not like their menstrual period (69%, 190/275) and preferred a menstrual frequency of every 3 months or never (58%, 164/281) with no differences between racial groups. When asked if they would consider using a birth control method that stopped their menstrual periods, 40% (111/278) reported yes, 28% (78/278) reported no and 32% (89/278) were undecided. However, significantly fewer black than white women would consider a birth control method to stop their menstrual periods (29% vs. 49%, p=.006).

Conclusions

Although the majority of US women surveyed dislike menstruation and prefer less frequent or no menstrual periods, black women were less accepting than white women of contraception that induces amenorrhea.

Introduction

In general, the majority of reproductive-age women would prefer menstruating less often than once a month or not at all [1], [2], [3], [4], [5], [6]. Furthermore, if given the ability to design a contraceptive, most would choose to bleed less often than once a month or never [1]. These attitudes and preferences regarding menstruation have mainly been studied in women of Northern European descent outside the United States.

Ethnic and cultural differences may exist in women's attitudes towards menstrual frequency and contraceptive-induced amenorrhea. Glasier et al. [2] surveyed women in China, Nigeria, South Africa and Scotland regarding the acceptability of amenorrhea associated with contraception. If given the choice, the majority of women preferred to have menstrual periods only every 3 months or less, except for Black women in Africa who preferred monthly periods. In addition, most women were open to using a method of contraception that induced amenorrhea, except for women in China. This study suggests that a woman's attitude towards bleeding and amenorrhea may be ethnically and/or culturally based. Of the two US studies, ethnic and cultural differences, as they relate to menstrual frequency and suppression, were not addressed [3], [4].

To determine whether attitudes regarding menstruation and contraception-induced amenorrhea differ among racial groups in the United States, we administered a validated survey instrument [2] to two geographically and racially diverse samples.

Section snippets

Methods

The Institutional Review Boards at Oregon Health and Science University, Emory University School of Medicine and Grady Memorial Hospital approved the study protocol. Completing the survey implied subject consent. The survey was performed between November 2003 and May 2004 at three sites in Portland, OR [the Clinics of Planned Parenthood of the Columbia-Willamette (PPCW) and the Oregon Health and Science University (OHSU) resident and faculty obstetrics/gynecology clinics], and one clinical site

Results

Approximately 350 surveys were dispersed with 311 surveys returned and 292 surveys eligible for analysis (Oregon, n=193; Georgia, n=99). Nineteen surveys were ineligible because the reported age was less than 18 years old.

Demographic characteristics of the Oregon and Georgia sites are shown in Table 1. The two samples differed significantly in regard to race (Oregon, 83% white; Georgia, 88% black), marital status (Oregon, 63% single; Georgia, 80% single), religion (Oregon, 35% Christian;

Discussion

Our study surveyed two racially diverse US sites to obtain women's preferences and attitudes regarding menstruation. Our findings are consistent with other published studies both in and outside the United States which report that the majority of women dislike their menstrual periods because of menstrual-associated symptoms and inconvenience. When given an option regarding menstrual frequency, the majority would chose a frequency of every 3 months or not at all. Whites, divorcees and women with

Acknowledgments

The authors would like to thank Dr. Anna Glasier who helped make this study possible through her generous collaboration.

References (7)

I. den Tonkelaar et al.
Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use, and hormone replacement therapy use
Contraception
(1999)
A.F. Glasier et al.
Amenorrhea associated with contraception — an international study on acceptability
Contraception
(2003)
L.C. Andrist et al.
Women's and providers' attitudes toward menstrual suppression with extended use of oral contraceptives
Contraception
(2004)

There are more references available in the full text version of this article.

Cited by (66)

A Social Media Survey of US Adolescent Preferences for Menstrual Bleeding Patterns
2024, Journal of Pediatric and Adolescent Gynecology
To assess preferences for menstrual pattern and acceptability and knowledge about the safety of induced amenorrhea among adolescents and young adults
We conducted a cross-sectional online survey of US residents aged 14-24 years at least 1 year post-menarche. Online recruitment was conducted via the social media platform TikTok on a teen reproductive health channel. Survey questions focused on menstrual history, menstrual pattern preferences, and demographic characteristics. The primary outcome was the proportion of postmenstrual individuals who would prefer amenorrhea vs scheduled bleeding.
From 5113 potential respondents who accessed the eligibility screening, 3001 completed surveys and met the inclusion criteria. Most were aged 14-18 (63.7%), distributed proportionally among all US Census regions. When asked if they could pick their period-bleeding style without any permanent impacts, almost three-quarters chose no bleeding at all (amenorrhea; 71.5%) compared with scheduled periods (28.5%). However, 63.7% agreed or were uncertain when faced with the statement “It might be unsafe if hormone medications stop your period bleeding.” After adjusting for age, gender expression, race, religion, heavy bleeding, and frequent bleeding, factors associated with preference for amenorrhea vs regular bleeding were younger age, masculine gender expression, White race, and non-Christian religious background. Baseline bleeding amount and frequency were not associated with preference for amenorrhea.
More than two-thirds of US adolescents and young adults indicated a preference for medication-induced amenorrhea if the method was assured to not have any permanent effects on the body, despite highly prevalent misconceptions about health and safety.
Caregiver goals and satisfaction for menstrual suppression in adolescent females with developmental disabilities: A prospective cohort study
2023, Disability and Health Journal
Adolescents with developmental disabilities and their caregivers often seek menstrual management. Caregivers frequently serve as medical decision-makers, and little is known about caregiver goals for menstrual management and satisfaction over time.
Assess caregiver reasons for initiating menstrual management in adolescents with disabilities and satisfaction over 12 months.
Prospective cohort study of caregivers of adolescents with developmental disabilities seeking menstrual management at a pediatric and adolescent gynecology clinic. Data derive from caregiver surveys and adolescents' electronic medical records.
Ninety-two caregiver-adolescent pairs enrolled. The mean age of adolescents was 14.4 (±2.6). The most common method started was levonorgestrel intrauterine device (LNG-IUD; 52, 56.5%), followed by oral norethindrone acetate (21, 22.8%). Caregivers cited hygiene concerns (84.8%), behavioral problems (52.2%), and heavy/excessive bleeding (48.9%) as reasons for initiating menstrual suppression. Caregivers who identified hygiene or heavy/excessive bleeding as the most important reason for management were more likely to select LNG-IUD (p = 0.009). Caregivers who cited behavioral/mood or seizure concerns as the most important reason were more likely to choose other methods (p < 0.05). At 12 months, caregiver satisfaction with all methods was high (66.2–86.9 on a 100-point scale). For every additional day of bleeding, satisfaction decreased by 3.7 points (95% CI: 2.3–5.0).
Caregiver satisfaction with all methods is high; however, it negatively correlates with days of bleeding. Caregiver reasons for menstrual suppression influence the method chosen. Management may reflect both patient and caregiver priorities; research is needed to better understand shared decision-making models that promote reproductive autonomy in adolescents with a developmental disability.
From menarche to menopause, heavy menstrual bleeding is the underrated compass in reproductive health
2022, Fertility and Sterility
Menstruation is defined as monthly uterine bleeding, regarded as a sign of reproductive health. When characterized by excessive bleeding (heavy menstrual bleeding [HMB]), it may act as a useful clinical marker for diagnosis of reproductive diseases. Endometrial and myometrial mechanisms underlying abnormal uterine bleeding (AUB), which includes HMB, have hormonal, cellular, and molecular aspects. Structural and nonstructural causes of AUB, presenting with HMB as the major symptom, result in iron depletion and consequent anemia. Heavy menstrual bleeding can be considered as a single entity to identify the possible underlying causes, which may be different to some extent to those of AUB, as a whole. Furthermore, the difficulties in defining HMB through objective methods do not allow the current epidemiological scenario on the prevalence of the symptom among reproductive-age women to be outlined. Moreover, the introduction of new diagnostic methods, including imaging technologies, entails a revision of the available figures on HMB in different age groups from menarche to menopause. In addition, a proper diagnostic algorithm for HMB should be implemented to adapt recommendations for clinical investigation when HMB is present.
Acceptability of the contraceptive Sayana® Press when injected every four months: Results from a twelve-month trial in Brazil, Chile and the Dominican Republic
2022, Contraception
Citation Excerpt :
However, contraceptive-induced menstrual changes were also the most common dislikes, reasons for discontinuing early from the study, and reasons participants would not want to use Sayana® Press in the future. This is consistent with literature that shows a wide variation of women's acceptability of contraceptive-induced menstrual changes across demographic factors and geographic locations [1, 17–21]. For example, a Brazil-based study found that women who preferred to menstruate compared to those who disliked menstruation were more likely to be less educated, have low socio-economic status, and have one or more child [22].
We assessed the acceptability of subcutaneous depot-medroxyprogesterone acetate 104 mg (Sayana® Press) when injected every 4 months for 12 months.
We assessed acceptability using questionnaires within a clinical trial to evaluate contraceptive effectiveness of Sayana® Press when the reinjection interval was extended from 3 to 4 months. We enrolled 750 women aged 18 to 35 years and at risk of pregnancy at 3 centers in Brazil, Chile, and the Dominican Republic who agreed to use Sayana® Press every 4 months for 12 months. Acceptability outcomes included responses to questions about perception of bleeding patterns and side effects, likes, and dislikes about the regimen. We descriptively compared outcomes across study centers and between those who completed the study and those who discontinued early.
Across the 3 centers, participants differed in age, marital status, years of schooling, and race. At the final visit, 90% reported being satisfied with Sayana® Press and 75% reported preferring to use this contraceptive every 4 months. The most common reasons women liked using Sayana® Press were for its duration of effectiveness, followed by amenorrhea. The most common dislike, when a reason was identified, was its effect on uterine bleeding, including amenorrhea reported by some participants. We also observed center-level differences in the proportion of women who liked amenorrhea.
Satisfaction with Sayana® Press injected every 4 months was high across the 3 demographically diverse Latin-American centers. However, participants had varied feelings towards contraceptive-induced amenorrhea.
We found that Sayana® Press when injected every 4 months was highly acceptable among women in 3 Latin American settings despite differences in their feelings toward contraceptive-induced amenorrhea. Our results suggest that there will be interest in using this method every 4 months if introduced into these settings.
Menstrual management considerations in the space environment
2021, REACH
Management of menstruation, pregnancy prevention, and mitigation of gynecologic-related pathology in the space environment with or without the use of hormonal modalities requires thorough counseling and complex decision-making. Factors that must be considered by astronauts and their physician teams range from desirability of contraception and/or menstrual suppression to weighing the risk and benefit profiles of various formularies of progesterone or combination estrogen and progesterone-containing hormonal modalities on various pathologies, including abnormal uterine bleeding, ovarian cyst production and risk of torsion, bone mineral density and osteopenia, venous thromboembolism, and cancer. Simultaneously, the choice to use or abstain from one of these modalities may also impact onboard mass, volume, and engineering considerations relating to stowage of onboard resources and sanitation products as well as impacting the design or function of waste management systems. While significant gynecological morbidity has not been reported during spaceflight, the objective of this review is to untangle these interrelated complexities to empower astronauts, physician and pharmacy teams, and engineering teams to enable the development of systems and protocols that support astronaut autonomy in reproductive decision-making and optimally mitigate future gynecologic risk.
Segesterone acetate serum levels with a regression model of continuous use of the segesterone acetate/ethinyl estradiol contraceptive vaginal system
2021, Contraception
Citation Excerpt :
The 0.15 mg SA/0.013 mg EE CVS was approved by the US Food and Drug Administration in August 2018 (Annovera®; TherapeuticsMD, Boca Raton, FL) for a year of use (13 cycles of 21 days in, followed by 7 days out) to prevent pregnancy [15]. While the design of cyclic use allows for regular monthly bleeding patterns that are familiar to many women, studies have shown that many women value reduction of menstruation frequency and symptoms associated with menstruation [16–25]. Extended-cycle or flexible continuous use of contraceptives may improve adherence [26], which could potentially further reduce the risk of pregnancy [22].
To predict serum segesterone (SA) and ethinyl estradiol (EE) levels after 364 days of hypothetical continuous use (without removal) of a cyclic contraceptive vaginal system (CVS) containing 0.15 mg SA and 0.013 mg EE.
We used pharmacokinetic (PK) data (n = 37) from a multicenter, open-label, nonrandomized study of healthy women (18–38 years) that used the CVS for 13 cycles in a 21 days-in/7 days-out regimen to develop a linear regression model to predict daily serum SA and EE levels for 364 days of continuous CVS use. We then determined residual SA/EE levels in vitro from 18 randomly chosen CVS used by women who completed 13 cycles. Serum SA and EE levels were also predicted for 364 days of continuous CVS use in another in vitro study.
After a hypothetical 364 days of continuous CVS use, we predicted daily mean serum levels to be 184 pmol/L (95% confidence interval [CI], 102‒332 pmol/L) for SA and 43 pmol/L (95% CI, 19‒95 pmol/L) for EE. We did predict that serum EE levels would not accumulate over time. Residual SA and EE in the CVS were 60% and 80% of the original load after 13 cycles, respectively.
The predicted serum SA level after 364 days of hypothetical continuous CVS use was comparable to reported levels at which no pregnancy occurred (>100 pmol/L), showing the potential of the CVS for one year of continuous use. Clinical trials on continuous CVS use are planned.
Based on statistical modeling, the long-term, user-controlled contraceptive vaginal system containing segesterone acetate and ethinyl estradiol may have the potential to provide effective pregnancy prevention if used continuously (without removal) for one year. Further investigation is warranted.

View all citing articles on Scopus

^☆: Financial support: HD 01243-03 (NICHD K-12).

View full text

Original research articleAcceptability of contraceptive-induced amenorrhea in a racially diverse group of US women☆

Abstract

Objective

Study Design

Results

Conclusions

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgments

Contraception

Contraception

Contraception

Original research article
Acceptability of contraceptive-induced amenorrhea in a racially diverse group of US women☆