What are the nearest formulations of Combined Hormonal Contraceptives (CHCs) with lower doses of natural estradiol that may have less side effects to stop menstruation for one month?

Combined Hormonal Contraceptives for Temporary Menstrual Suppression

For temporary menstrual suppression for one month of travel, the vaginal ring (NuvaRing) is the optimal choice due to its lower estrogen dose (15 μg ethinyl estradiol), simple regimen, and excellent cycle control. 1

Recommended Options (from lowest to higher estrogen dose)

• Vaginal Ring (NuvaRing) - First choice

  • Contains 15 μg ethinyl estradiol and 120 μg etonogestrel daily 1, 2
  • For menstrual suppression: insert a new ring immediately after removing the previous one (skip the ring-free week) 1
  • Advantages: lowest systemic estrogen exposure, simple to use, excellent cycle control 2, 3
  • High satisfaction rates (>90% of users satisfied) and easy to insert/remove 4
  • Common side effects: vaginal discharge, occasional discomfort, headache 2

• Low-dose Combined Oral Contraceptives

  • Monophasic pills containing 20-30 μg ethinyl estradiol 1
  • For menstrual suppression: skip the placebo pills and start a new pack immediately 1
  • Advantages: widely available, can be started immediately 1
  • Common side effects: headache, nausea, breakthrough bleeding 1

• Contraceptive Patch

  • Contains higher estrogen exposure (equivalent to 35 μg ethinyl estradiol) 1
  • For menstrual suppression: apply a new patch immediately after removing the third patch 1
  • Note: FDA has identified increased estrogen exposure (1.6 times higher than low-dose COCs) 1

Implementation Instructions

For NuvaRing (Recommended Option):

1. Insert ring and leave in place for 3 weeks 1
2. Instead of removing for a ring-free week, remove and immediately insert a new ring 1
3. Continue this pattern until menstrual bleeding is desired again 1
4. When ready to resume normal cycling, remove ring after 3 weeks and have a ring-free week 1

For Combined Oral Contraceptives:

1. Take active pills continuously, skipping the placebo pills 1
2. Start a new pack immediately after finishing the active pills in the current pack 1
3. When ready to resume normal cycling, take a 7-day pill-free break after completing active pills 1

Clinical Considerations

• Extended or continuous cycle regimens are particularly appropriate for temporary menstrual suppression for travel 1
• The most common adverse effect of extended-cycle regimens is unscheduled breakthrough bleeding, which decreases over time 1
• Eliminating the hormone-free interval optimizes ovarian suppression, potentially increasing contraceptive effectiveness 1
• For patients not currently on hormonal contraception, start the method at least 7 days before travel to ensure adequate contraceptive coverage and assess initial tolerability 1

Important Caveats

• If starting a new method, begin at least 7-10 days before travel to monitor for side effects 1
• Breakthrough bleeding is more common when first using extended regimens but typically improves with continued use 1
• If the patient has risk factors for venous thromboembolism, consider non-hormonal options instead 1
• The vaginal ring can be removed for up to 3 hours if desired (though not typically recommended) 1
• For patients who prefer pills, monophasic formulations are easier to use for extended cycles than multiphasic ones 1

By using the vaginal ring with its lower estrogen dose and simple administration, your patient can effectively suppress menstruation during travel while minimizing potential side effects 2, 4.