Use of hormonal contraceptives to control menstrual bleeding: attitudes and practice of Brazilian gynecologists

María Y Makuch,¹ Maria José D Osis,¹ Karla Simonia de Pádua,^1,2 Luis Bahamondes<sup>3

1</sup>Center for Research in Reproductive Health (CEMICAMP), ²Prof Dr José Aristodemo Pinotti Women's Hospital, University of Campinas, ³Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, and National Institute of Hormones and Women's Health, Campinas, São Paulo, Brazil

Background: The purpose of this study was to assess the attitudes and prescribing practices of Brazilian obstetricians and gynecologists regarding use of contraceptive methods to interfere with menstruation and/or induce amenorrhea.
Methods: We undertook a nationwide survey of Brazilian obstetricians and gynecologists selected using a computer-generated randomization system. Participants completed a questionnaire on prescription of contraceptives and extended/continuous regimens of combined oral contraceptives (COCs).
Results: In total, 79.2% of Brazilian obstetricians and gynecologists reported that 20%–40% of their patients consulted them for menstrual-related complaints and 26%–34% of the gynecologists reported that 21%–40% of their patients consulted them for reduction in the intensity, frequency, and/or duration of menstrual bleeding. Overall, 93% stated that medically induced amenorrhea represents no risk to women's health and 82.5% said that they prescribed contraceptives to control menstruation or induce amenorrhea. The contraceptives most commonly prescribed were extended-cycle 24/4 or 26/2 COC regimens and the levonorgestrel-releasing intrauterine system. Poisson regression analysis showed that Brazilian obstetricians and gynecologists prescribing contraceptives to control menstruation or induce amenorrhea consider extended-use or continuous-use COC regimens to be effective for both indications (prevalence ratio 1.23 [95% confidence interval 1.09–1.40] and prevalence ratio 1.28 [95% confidence interval 1.13–1.46], respectively). They also prescribed COCs with an interval of 24/4 or 26/2 to control bleeding patterns (prevalence ratio 1.10 [95% confidence interval 1.01–1.21]).
Conclusion: Brazilian obstetricians and gynecologists were favorably disposed toward prescribing extended-use or continuous-use COC regimens for control of menstrual bleeding or to induce amenorrhea on patient demand.

Keywords: menstruation, induced amenorrhea, gynecologists, Brazil, hormonal contraceptives