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 Bahamondes3
1Center 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
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