What is the most effective form of contraception for a woman with Down syndrome to achieve amenorrhea (absence of menstruation)?

From the Guidelines

For individuals with Down syndrome who want to stop periods, the levonorgestrel intrauterine device (Mirena or Kyleena) is often the best option, as it can significantly reduce or stop periods for 3-7 years depending on the specific device, with the added benefit of being a long-acting reversible contraceptive method. When considering birth control for someone with Down syndrome, it's essential to account for any medical conditions common in Down syndrome, such as heart conditions or thyroid issues, which might affect which method is safest 1. The decision should involve the individual to the extent possible, along with healthcare providers and caregivers, considering factors like the ability to take pills consistently, comfort with procedures, and specific health needs. Some key points to consider when choosing a birth control method for individuals with Down syndrome include:

• The ability to reduce or eliminate menstrual bleeding, which can be beneficial for individuals who experience heavy or painful periods
• The potential for the method to be used as a long-acting reversible contraceptive, reducing the need for daily or weekly adherence
• The importance of regular follow-up appointments to monitor for side effects and ensure the chosen method is working effectively, as recommended by the U.S. selected practice recommendations for contraceptive use, 2013 1. It's also important to note that other options, such as continuous or extended-cycle combined hormonal contraceptives, progestin-only pills, and the hormonal implant, may also be effective in reducing or eliminating menstrual bleeding, but may have different benefits and drawbacks that should be considered on an individual basis.

From the FDA Drug Label

Medroxyprogesterone Acetate Injectable Suspension, USP is indicated only for the prevention of pregnancy The effectiveness of Medroxyprogesterone Acetate Injectable Suspension, USP is dependent on the patient returning every 3 months (13 weeks) for reinjection In five clinical studies using Medroxyprogesterone Acetate Injectable Suspension, USP, the 12-month failure rate for the group of women treated with Medroxyprogesterone Acetate Injectable Suspension, USP was zero (no pregnancies reported) to 0. 7 by Life-Table method.

The medroxyprogesterone acetate (IM) is a highly effective form of birth control, with a low failure rate of 0 to 0.7% in the first year of use 2. However, the question of whether it is the best birth control for Down syndrome to stop periods cannot be directly answered as the label does not provide information on the relationship between medroxyprogesterone acetate (IM) and Down syndrome.

• The label does indicate that medroxyprogesterone acetate (IM) is effective in preventing pregnancy.
• It does not provide information on its effect on menstrual cycles or Down syndrome. The FDA drug label does not answer the question.

From the Research

Birth Control Options for Down Syndrome to Stop Periods

• The management of contraceptives and menstrual complaints in patients with Down syndrome is crucial for improving their overall quality of life 3.
• Contraceptive measures can be used for both contraception and control of menstrual symptoms, and the physician must make an individualized recommendation aimed at offering the most efficient and least invasive method with the fewest side effects 3.
• Medical options for birth control include oral contraceptives, quarterly injectable medroxyprogesterone acetate, oral progesterone, a levonorgestrel-releasing intrauterine system, transdermal patch, and vaginal rings 3.

Levonorgestrel-Releasing Intrauterine System (LNG-IUD)

• The LNG-IUD is a highly effective and safe form of long-term yet reversible birth control that offers potential therapeutic benefits in other clinical contexts, including menorrhagia, symptomatic fibroids, endometriosis, and endometrial suppression 4.
• The LNG-IUD has been shown to reduce menstrual blood loss, pelvic pain, and dysmenorrhea, and improve the staging of endometriosis and adenomyosis 5, 6.
• The LNG-IUD is beneficial for symptom recurrence and endometriotic cyst recurrence after conservative surgery for patients with severe pain related to endometriosis 6.

Considerations for Individuals with Down Syndrome

• Individuals with Down syndrome may have a higher incidence of disorders related to menstruation, such as hypothyroidism, epilepsy, and use of anticonvulsants, which must be taken into account when selecting a birth control method 3.
• The presumption of infertility in Down syndrome is based on old studies, and access to procreation is an emerging debate 7.
• The use of birth control methods, including the LNG-IUD, can help manage menstrual symptoms and improve the quality of life for individuals with Down syndrome 3, 6.