Elective amenorrhea, or menstrual suppression, involves using specialized medical treatments to stop or significantly limit the frequency of menstruation. Individuals seek this approach for reasons ranging from personal preference and convenience to managing significant medical conditions. Interventions fall into two main categories: reversible hormonal treatments and permanent procedural or surgical methods. This article focuses exclusively on medical options for menstrual cessation that require professional oversight.
Hormonal Suppression Methods
The most common and least invasive path to stopping menses involves long-acting hormonal therapies. These therapies work by preventing the monthly buildup and shedding of the uterine lining, known as the endometrium. Suppression is primarily achieved through the continuous delivery of progestin, often combined with estrogen, which maintains a thin, stable lining. Eliminating the hormone-free interval prevents the withdrawal bleed commonly mistaken for a true menstrual period.
Continuous-dose oral contraceptives are a highly effective method where active hormone pills are taken daily without a week of placebo pills. This regimen avoids the drop in hormone levels that signals the uterine lining to shed, leading to amenorrhea over time. Extended-cycle regimens, such as those formulated for 84 days of active pills followed by a short break, achieve the same goal but allow for bleeding four times a year instead of monthly.
Long-acting reversible contraceptives (LARCs) also utilize progestin to suppress the menstrual cycle. The levonorgestrel-releasing intrauterine device (IUD) releases the hormone directly into the uterus, causing significant localized thinning of the endometrium. This action leads to amenorrhea in approximately 50 to 60% of users over the first year. Similarly, the etonogestrel implant, a small rod inserted under the skin, releases a steady dose of progestin that inhibits ovulation and thins the uterine lining.
Another progestin-only option is the injectable medroxyprogesterone acetate (Depo-Provera), administered every three months. This high dose of progestin prevents ovulation and causes pronounced thinning of the uterine lining, resulting in amenorrhea for many users after the second or third injection. These hormonal approaches offer a reversible pathway to menstrual cessation, with normal cycles typically returning months after the method is discontinued.
Procedural Solutions for Menstrual Cessation
When hormonal options are ineffective or medically contraindicated, procedural interventions that physically alter the uterus can be considered. The most common is endometrial ablation, a minimally invasive technique that permanently destroys the tissue lining the uterus (the layer that sheds during menstruation). The procedure is typically performed in an outpatient setting using instruments inserted through the cervix, avoiding surgical incisions.
Ablation methods vary and can include the use of extreme cold, heated fluids, or radiofrequency energy to destroy the endometrium. The goal is to reduce or eliminate menstrual bleeding; studies show that 80 to 90% of women experience significantly lighter periods, and up to 50% achieve complete amenorrhea. Endometrial ablation is effective for bleeding cessation, but it is not a form of sterilization.
Pregnancy remains possible after the procedure, but it is highly discouraged and carries substantial risk to both the woman and the fetus due to the damaged uterine environment. Therefore, women who undergo endometrial ablation must continue to use reliable contraception or pursue surgical sterilization. Ablation is considered for women who have completed childbearing and experience heavy or prolonged uterine bleeding that has not responded to medical management.
Permanent Surgical Removal Options
The most permanent method for stopping menstruation is surgical removal of the reproductive organs, generally reserved for cases where other treatments have failed or a serious underlying medical condition exists. A hysterectomy involves the surgical removal of the uterus, which immediately eliminates the possibility of a menstrual period. The procedure can range from a supracervical hysterectomy (where the upper part of the uterus is removed and the cervix is left intact) to a total hysterectomy (which removes both the uterus and the cervix).
The decision to remove the ovaries (oophorectomy) at the same time is a separate consideration. If the ovaries are preserved, they continue to produce hormones, and the individual will not experience surgical menopause. Removing both ovaries, however, induces immediate surgical menopause because the body’s primary source of estrogen is eliminated. Due to the permanent consequences, a hysterectomy is typically considered only as a last resort for non-malignant conditions, such as large fibroids or intractable pain from severe endometriosis.
Medical Justifications and Safety Considerations
Menstrual suppression is often medically indicated to treat conditions where the monthly cycle causes significant health impairment. A common justification is severe, heavy menstrual bleeding (menorrhagia), which can lead to iron-deficiency anemia. Suppressing the cycle mitigates blood loss, allowing iron levels to recover. Suppression is also a frontline treatment for pain associated with conditions like endometriosis or uterine fibroids.
Some individuals experience conditions exacerbated by hormonal fluctuations, such as menstrual-related migraines or cyclical mood disorders. These can be managed by maintaining stable hormone levels through continuous suppression. Skipping a period is safe because hormonal methods thin the uterine lining, preventing the buildup that the body needs to shed. The concept of “cleansing” the body by having a period is a misconception when using these medical interventions.
All medical interventions carry specific safety considerations that must be discussed with a provider.
Safety Considerations
- Combined hormonal suppression methods, which contain estrogen, are associated with a small but increased risk of venous thromboembolism (blood clots) compared to non-users.
- Progestin-only methods, such as the hormonal IUD or implant, carry minimal or no increased risk for blood clots.
- The injectable Depo-Provera is linked to a reversible decrease in bone mineral density with long-term use, prompting recommendations for its use to be limited to two years unless other options are unsuitable.
- Permanent procedures like hysterectomy or ablation carry the risks of major surgery and irreversible consequences.
The decision to pursue menstrual cessation, whether reversible or permanent, requires careful evaluation of individual health history, lifestyle needs, and long-term goals.