What medications can temporarily stop menstrual cycles in a female patient of reproductive age?

Medications That Can Temporarily Stop Menstrual Cycles

The most effective medication for temporarily stopping menstrual cycles is depot medroxyprogesterone acetate (DMPA), which achieves amenorrhea in the majority of users after one year of continuous use, followed closely by the levonorgestrel-releasing intrauterine device (LNG-IUD), which achieves complete amenorrhea in 22% of users. 1

First-Line Options for Menstrual Suppression

Depot Medroxyprogesterone Acetate (DMPA)

• DMPA 150 mg intramuscularly or 104 mg subcutaneously every 13 weeks is highly effective for long-term menstrual suppression. 1
• Nearly all patients experience menstrual irregularities initially, but these improve over time with amenorrhea becoming common after ≥1 year of continuous use. 2, 1
• The two formulations (150 mg IM vs 104 mg SC) differ only in route of administration, with equivalent efficacy. 1

Levonorgestrel-Releasing Intrauterine Device (LNG-IUD)

• The LNG-IUD is the single most effective option for long-term menstrual suppression, achieving 71-95% reduction in menstrual blood loss with 22% of users experiencing complete amenorrhea. 1, 3
• Particularly useful for adolescents and women with medical conditions requiring long-term menstrual suppression where estrogen is contraindicated. 1
• Works primarily at the endometrial level with minimal systemic progesterone absorption. 3

Alternative Hormonal Options

Combined Oral Contraceptives (COCs) - Extended/Continuous Regimens

• Monophasic COCs containing 30-35 μg of ethinyl estradiol can be taken continuously (skipping placebo pills) to suppress menstruation. 2
• The CDC recommends taking active pills continuously for 3-4 months, followed by a 4-7 day hormone-free interval. 2
• If breakthrough bleeding occurs, a 3-4 day hormone-free interval can be taken (but not during the first 21 days of use and not more than once per month). 2, 1
• Extended regimens are particularly useful for treating anemia, severe dysmenorrhea, and heavy menstrual bleeding. 2

Etonogestrel Implant

• Associated with 22% of users experiencing amenorrhea and 34% experiencing infrequent spotting. 1
• However, 7% report frequent bleeding and 18% report prolonged bleeding. 1

Cyclic Oral Progestins

• Reduce menstrual blood loss by approximately 87% and typically result in eventual reduction to light bleeding only. 1, 3
• Less effective than LNG-IUD but more effective than no treatment. 3

Managing Breakthrough Bleeding

For DMPA Users

• NSAIDs for 5-7 days can be effective for heavy or prolonged bleeding. 2
• Rule out underlying gynecological problems such as STDs, pregnancy, or new pathologic uterine conditions (polyps or fibroids). 2

For Implant Users

• Celecoxib 200 mg daily for 5 days or mefenamic acid 500 mg three times daily for 5 days can achieve bleeding cessation within 7 days. 1
• Estrogen, daily COCs, or tranexamic acid can reduce bleeding days during treatment. 1

For COC Users (Extended Regimens)

• NSAIDs for 5-7 days can be used for breakthrough bleeding. 2
• A 3-4 day hormone-free interval may help (but not during first 21 days of use and not more than once per month). 2
• Before treating breakthrough bleeding, rule out pregnancy, medication interactions, cigarette smoking, or new pathologic uterine conditions. 1

Critical Counseling Points

• Enhanced counseling about expected bleeding patterns before initiating any hormonal method reduces discontinuation rates. 2, 1, 3
• Patients should be reassured that amenorrhea during hormonal contraceptive use is generally not harmful and does not require medical treatment. 1
• Unscheduled bleeding is common during the first 3-6 months of extended or continuous use and generally decreases with continued use. 2
• Cessation of menses alone is not an adequate indicator of ovarian suppression, and patients should be alert to physiologic changes suggesting recovery of ovarian function. 1
• Complete amenorrhea may be difficult to achieve, and patients should be counseled about realistic expectations. 1

Important Contraindications and Precautions

• Rule out pregnancy before initiating any hormonal therapy. 1
• In women with spontaneous coronary artery dissection, hormonal therapy including progesterone is relatively contraindicated. 1, 3
• Injectable DMPA causes fluid retention and is inappropriate for patients with heart failure. 2
• Blood pressure should be monitored at follow-up visits for patients on COCs. 2