Large gap between physician and patient understanding of necessity of monthly periods

Oct 4 2007

More than the two thirds of the women in a national survey say that they are interested in suppressing their menstrual periods but many of them aren't sure if it's safe.

Yet when physicians are polled, 97 percent say that continuous oral contraceptive therapy to suppress menstruation is, in fact, medically safe and acceptable. The survey results were presented by Kurt Barnhart MD, MSCE from the University of Pennsylvania School of Medicine at the Association of Reproductive Health Professionals' (ARHP) Reproductive Health 2007 conference.

“The gap between physician and patient understanding concerning the necessity of monthly periods is obvious,” said Dr. Barnhart, Associate Professor and Director of Clinical Research for the Department of Obstetrics & Gynecology. “It is our hope that based on these findings physicians will begin to more readily initiate dialogue with their female patients about continuous therapy -- helping to eliminate the misconception that periods are a medical necessity and to emphasize the safety and viability of menstrual suppression.”

Multiple oral contraceptives are already available to reduce menstruation and the FDA recently approved the first continuous oral contraceptive designed to suppress a woman's menstrual cycle. And according to this study, women are increasingly interested in exercising their options. The study found that 63 percent of women reported being extremely or somewhat interested in not having a period. Symptoms cited as the most bothersome aspects of menstruation included cramping, mood swings, bloating and headaches/body aches, while associated personal frustrations cited included avoiding exercise and sexual intercourse, eating more and a decrease in work productivity.

Why would a physician recommend a woman suppress her menses?

“The symptoms that often accompany menstruation – from depression to bloating and headaches – can significantly disrupt women's lives,” said Dr. Barnhart. “Menstruation is not medically necessary. Now that we have products that have proven to be safe and effective at suppressing menstruation, we can offer increasing options for women.”

Indeed it seems a clearer patient-physician dialogue is required to eliminate confusion regarding menstrual suppression and continuous use oral contraceptives. Of the 12% of patients who indicated that they have discussed the idea of eliminating or reducing periods with their doctor; nearly half of those said that they were the ones to raise the issue, not their physicians. But their physicians tell a different story. By contrast, four out of 5 physicians reported discussing continuous use oral contraceptive use with their patients, and 77% reported that they raised the topic.

This disconnect may be related to simple semantics, according to Dr. Barnhart.

“We've found that physicians and their patients discuss this topic differently, with doctors using the medical term menstrual suppression, while their patients simply talk about not having a period,” he said. “Breaking down this language barrier by speaking in simpler, more patient-friendly terms could have a significant positive impact on understanding.”

Oral contraceptives were initially designed with a week of inactive tablets taken every month to mimic the natural experience of menstruation. Continuous use oral contraceptives simply eliminate these inactive tablets, thereby eliminating withdrawal bleeding. A study published in the December, 2006 issue of Contraception demonstrated the safety and effectiveness of continuous-use oral contraceptives that can eliminate menstrual cycles. Researchers concluded that a continuous-use, low-dose regimen of oral contraceptives was safe and as effective as traditional oral contraceptives, and that the decrease in menstrual cycle symptoms during continuous use therapy represented an increase in quality of life.