From the Guidelines
Temporary period-stopping medications should be chosen based on the patient's individual health history and needs, with options including hormonal contraceptives like combined oral contraceptives, progestin-only pills, hormonal IUDs, contraceptive implants, and injectable contraceptives, as recommended by the most recent guidelines 1. When considering temporary period-stopping medications, it is essential to explore patient goals and provide reassurance, as well as advise on potential treatment options, including NSAIDs, hormonal treatment, and antifibrinolytic agents, depending on the patient's preferences, treatment goals, and medical history 1. Some key points to consider when selecting a temporary period-stopping medication include:
- The patient's medical history and potential interactions with other medications
- The patient's preferences and treatment goals
- The potential side effects of the medication, such as breakthrough bleeding, breast tenderness, headaches, or mood changes
- The need for consultation with a healthcare provider to determine the most appropriate option According to the 2024 guidelines, treatment options for bleeding irregularities while using contraception may include:
- NSAIDs for 5-7 days
- Hormonal treatment, such as low-dose COCs or estrogen, for 10-20 days
- Antifibrinolytic agents, such as tranexamic acid, for 5 days It is crucial to consider the patient's individual needs and health history when selecting a temporary period-stopping medication, and to consult with a healthcare provider to determine the most appropriate option 1.
From the Research
Temporary Period Stopping Medications
There are several studies that have investigated the use of hormonal medications to stop or reduce menstrual bleeding.
- The study 2 found that a 24-day regimen of norethindrone acetate and ethinyl estradiol was effective in reducing intracyclic bleeding and withdrawal bleeding compared to a 21-day regimen.
- Another study 3 compared the effects of continuous combined hormone replacement therapy with norethindrone acetate and ethinyl estradiol to conjugated equine estrogens and medroxyprogesterone acetate, and found that the norethindrone acetate and ethinyl estradiol combination was associated with a greater incidence of amenorrhea.
- A study 4 found that continuous ethinyl estradiol and norethindrone acetate therapy reduced vaginal bleeding and spotting compared to sequential therapy.
- The study 5 compared the effects of combined norethindrone acetate and low-dose ethinyl estradiol therapy to combined conjugated equine estrogens and medroxyprogesterone acetate therapy, and found that the norethindrone acetate and ethinyl estradiol combination reduced the incidence and duration of vaginal bleeding.
Mechanism of Action
The exact mechanism of action of these medications in stopping or reducing menstrual bleeding is not fully understood, but it is thought to be related to the hormonal effects on the endometrium.
- The study 6 found that lowering the dose of norethindrone in an oral contraceptive increased estrogen and progesterone receptor levels in breast epithelial cells, but did not reduce proliferation of breast epithelium.
Types of Medications
There are several types of medications that can be used to stop or reduce menstrual bleeding, including: