The aim of this study was to review the efficacy of different medical modalities for menstrual suppression in the cohort of patients with disabilities who presented to the Queensland Paediatric and Adolescent Gynaecology (PAG) Service between January 2005 and December 2015. Menstrual suppression in adolescents with disabilities is an important aspect of care to support the patient and their carers in managing the complexities of menstrual hygiene, pain, and other discomfort associated with menses. It is important for general practitioners, pediatricians, and gynecologists to establish the right modality of suppression for each individual adolescent.
Design, Settings, Participants, Interventions, and Main Outcome Measures
The study was a retrospective case notes review of 68 adolescents who presented to the Queensland PAG Service, Brisbane, Australia with a request for menstrual suppression. The medical interventions included treatment with either combined oral hormonal contraceptive, oral medroxyprogesterone, depot medroxyprogesterone, or the levonorgestrel intrauterine system (Mirena, Bayer). The primary outcome measure was success of menstrual suppression from commencement of medical intervention to achievement of complete amenorrhea or very light bleeding described as spotting, for each medical modality. Secondary outcomes were length of time from first treatment to first observed menstrual suppression, and the number of outpatient appointments taken to achieve menstrual suppression.
Of the 68 adolescents, 59/68 (86.8%) successfully achieved menstrual suppression, with 9/68 (13.2%) having ongoing treatment or loss to follow-up at the time of conclusion of the study; 39/68 (57.4%) were menstrually suppressed with their chosen medical modality after their initial appointment.
Medical modalities are highly effective in achieving menstrual suppression and no young women at this institution required a hysterectomy. Depot medroxyprogesterone was the most successful modality used to achieve menstrual suppression followed by the levonorgestrel intrauterine system. The combined oral hormonal contraceptive was the least successful medical treatment in achieving menstrual suppression.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Pediatric and Adolescent Gynecology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Adolescents with special needs: clinical challenges in reproductive health care.J Pediatr Adolesc Gynecol. 2016; 29: 2
- Menstrual management in developmentally delayed adolescent females.Aust N Z Obstet Gynaecol. 2017; 57: 346
- Trends in menstrual concerns and suppression in adolescents with developmental disabilities.J Adolesc Health. 2013; 53: 407
- Assessing methods of menstrual management of adolescents with developmental delay across specialties.J Pediatr Adolesc Gynecol. 2018; 31: 193
- Levonorgestrel-releasing intrauterine device use in female adolescents with heavy menstrual bleeding and bleeding disorders: single institution review.J Pediatr Adolesc Gynecol. 2017; 30: 479
- Treatment modalities in adolescents who present with heavy menstrual bleeding.J Pediatr Adolesc Gynecol. 2018; 31: 451
- Heavy menstrual bleeding in adolescents.J Pediatr Adolesc Gynecol. 2017; 30: 335
- Menstrual suppression by Mirena IUD insertion in adolescents with disabilities; using USS measures of uterine cavity length to predict procedural success.J Pediatr Adolesc Gynecol. 2017; 30: 304
- Consensus statement: menstrual and contraceptive management in women with an intellectual disability.Aust N Z Obstet Gynaecol. 2003; 43: 109
- Menstrual management for adolescents with disabilities.Pediatrics. 2016; 138: e1
- Oral contraceptive use and bone density in adolescent and young women.Contraception. 2011; 81: 35
- Menstrual suppression in special circumstances.J Obstet Gynaecol Can. 2014; 36: 915
- Menstrual suppression for adolescents.Curr Opin Obstet Gynecol. 2014; 26: 323
- Improvement in seizure control after initiation of depot medroxyprogesterone acetate.J Pediatr Adolesc Gynecol. 2017; 30: 325
Published online: June 07, 2019
The authors indicate no conflicts of interest.
Crown Copyright © 2019 Published by Elsevier Inc. on behalf of North American Society for Pediatric and Adolescent Gynecology. All rights reserved.