What medication can be used to stop menstruation?

Medications to Stop Menstruation

Combined hormonal contraceptives used in extended or continuous regimens are the most effective medications for stopping menstrual periods. 1

First-Line Options

Combined Hormonal Contraceptives (CHCs)

• Can be used in extended or continuous regimens to reduce or eliminate menstrual bleeding
• Extended regimens involve taking active hormone pills for longer than the traditional 21 days
• Continuous regimens involve taking active hormone pills without a hormone-free interval
• Available forms:
  • Combined oral contraceptive pills (COCPs)
  • Contraceptive vaginal ring (CVR)
  • Contraceptive patch

Efficacy for Menstrual Suppression

• Extended and continuous CHC regimens are more effective at suppressing menstruation than traditional 28-day cycles 1
• These regimens decrease estrogen-withdrawal symptoms and provide more reliable ovulation suppression 1
• Breakthrough bleeding and spotting may occur initially but typically decrease over time with continued use 1

Second-Line Options

Progestin-Only Methods

• Depot medroxyprogesterone acetate (DMPA) injections
  • Often leads to amenorrhea with continued use
  • Approximately 50-60% of users experience amenorrhea after 1 year of use
• Levonorgestrel intrauterine device (LNG-IUD)
  • More effective than COCPs in reducing menstrual blood loss 2
  • May lead to amenorrhea in some users over time
• Progestin implants
  • May cause irregular bleeding initially but can lead to amenorrhea in some users

Important Considerations

Safety Considerations

1. Age and smoking status:

   • Women over 35 who smoke should not use CHCs due to increased cardiovascular risks 3
   • Non-smoking women over 35 should use CHCs with caution 3

2. Medical contraindications:

   • CHCs are contraindicated in women with:
     • Uncontrolled hypertension (BP ≥160/100 mmHg)
     • History of venous thromboembolism (VTE)
     • Stroke or cardiovascular disease
     • Active liver disease or tumors
     • Migraine with aura 3

3. Alternative options for high-risk women:

   • Progestin-only methods (pills, implants, IUDs) are safer alternatives for women with contraindications to CHCs 3
   • Non-hormonal methods such as copper IUD are also safer alternatives 3

Monitoring and Management

• Regular monitoring of blood pressure is recommended for women using CHCs 3
• Breakthrough bleeding is common, especially during initial use of hormonal methods 4
• If breakthrough bleeding occurs:
  • Rule out pregnancy or pathology as causes 4
  • Consider changing to a preparation with higher estrogen content if necessary, though this may increase thromboembolism risk 4

Efficacy Comparison

• Long-Acting Reversible Contraceptives (LARCs) such as IUDs or implants have the lowest failure rates (<1%) 3
• Injectable contraception (DMPA) has failure rates of 0.3-6% 3
• Combined hormonal contraceptives have typical failure rates of 5-9% 3

Common Pitfalls and Caveats

• Breakthrough bleeding is a frequent reason for discontinuation of hormonal contraceptives 4, 5
• Each additional day of bleeding is associated with a 2-4% increase in discontinuation, depending on method type 6
• Missed periods while using hormonal contraceptives:
  • If the patient has not adhered to the prescribed schedule, pregnancy should be considered 4
  • If the patient has adhered to the regimen and misses two consecutive periods, pregnancy should be ruled out before continuing 4

Extended and continuous regimens of CHCs offer many benefits beyond menstrual suppression, including greater contraceptive efficacy and decreased estrogen-withdrawal symptoms, but are currently underutilized despite high user satisfaction 1.