ACOG’s Latest Guidance Highlights Critical Role of Hormonal Medications for Menstrual Suppression

Washington, D.C. – As reports surface questioning future access to reproductive medical care, including the hormonal medications used for contraceptive purposes, the American College of Obstetricians and Gynecologists (ACOG) has released timely guidance that illustrates the important role of hormonal medications in reproductive health care aside from preventing pregnancy.

The Clinical Consensus, "General Approaches to Medical Management of Menstrual Suppression," outlines the range of options for suppressing menstruation to address different objectives for people whose lives would benefit from a reduction in periods, including but not limited to transgender and gender-diverse patients; people with physical or cognitive disabilities or both; people who are incarcerated; those experiencing homelessness; and those with limited hygiene and privacy resources, such as military personnel deployed to war zones.

The treatment is valuable to transgender and gender-diverse patients, said Kathryn C. Stambough, MD, FACOG, a coauthor of the guidance, because "for some transgender and gender-diverse individuals, ongoing menstruation can lead to serious gender dysphoria, which can be damaging to mental health. Menstruation suppression is a safe way—supported by science—for clinicians to alleviate that distress and to improve patients' lives."

Menstrual suppression typically involves the use of hormonal medications such as oral contraceptive pills, patches, vaginal rings, injected progestin, and certain intrauterine devices and implants to safely eliminate or decrease the frequency and volume of menstrual periods. When choosing a method, clinicians consider factors including treatment effectiveness and contraindications or risk factors, such as drug interactions. Medical menstrual suppression does not affect future fertility or increase the risk of cancer.

The Clinical Consensus is intended to guide obstetrician–gynecologists in laying out the pros and cons of each method given patients' varying preferences and goals. It emphasizes the importance of patient autonomy, the critical absence of coercion, and shared decision making between patients and clinicians. The guidance also points to racial and ethnic disparities in access to hormonal therapy and prescribed contraception and acknowledges that most data focus on white populations. Clinicians counseling patients on menstrual suppression should be mindful of the complex effects of racism; how a clinician's implicit bias may affect which methods to offer patients; and varying cultural experiences and beliefs relating to menstrual health, fertility, and menstrual hygiene.

Additionally, the Clinical Consensus emphasizes engaging in shared decision making with patients and addressing patient and caregiver concerns and expectations, including providing guidance before the onset of menstruation as a means of lessening anticipatory anxiety for those with cognitive disabilities, developmental disabilities, or both and considering which specific issues may guide the choice of menstrual suppression.

Adolescents are among those of reproductive age who may also benefit from menstrual suppression. Oluyemisi Adeyemi-Fowode, MD, FACOG, one of the Clinical Consensus authors and a specialist in pediatric and adolescent gynecology, said, "Menstrual suppression can be a valuable medical intervention for people who menstruate but whose health and quality of life would be improved by reducing periods. When counseling patients about menstrual suppression, clinicians should take care to advise about common misconceptions about hormonal therapy and to foster reasonable expectations, including noting that complete amenorrhea may not be achievable."

"General Approaches to Medical Management of Menstrual Suppression" is now available.