Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use, and hormone replacement therapy use

Abstract

This study addresses attitudes towards changes in menstrual bleeding patterns caused by oral contraceptives (OC) or hormone replacement therapy (HRT) and preferred changes in bleeding pattern with and without use of OC or HRT in relation to reproductive age group. Data were collected by means of telephone interviews with 325 women in each of four age groups (15–19, 25–34, 45–49, and 52–57 years). In total, 80.5% of currently menstruating women preferred one or more changes in bleeding pattern such as less painful, shorter, or less heavy periods, or amenorrhea. The majority of the menstruating women in all age groups preferred to have a bleeding frequency of less than once a month or never, whether the bleeding was spontaneous or induced by OC. In the case of HRT, amenorrhea was most preferred. These findings with respect to preferred bleeding frequency and OC may have important implications for health care providers and for future contraception development.

Introduction

There is a wealth of literature relating to knowledge of menstruation (mainly studied in young women),1 cross-cultural differences in perceptions of menstruation2, 3 and women’s experience of the menstrual cycle (often focusing on menstrual distress and premenstrual tension or syndrome).4, 5, 6 Existing instruments for the measurement of attitudes towards menstruation have been developed mainly for the study of menstrual symptomatology.7

During the period 1973 to 1979, the World Health Organization (WHO) carried out a study of perceptions about menstruation from a different perspective.8 The authors wished to gain a better understanding of, among other things, women’s attitudes towards changes in their bleeding patterns as a consequence of contraceptive use in different cultural settings. These attitudes were considered relevant “because the study of menstruation has taken on a new perspective because of changes that most modern fertility regulating methods cause in bleeding patterns.” Inasmuch these attitudes may influence women’s decisions about the use and continued use of contraceptives, knowledge of such attitudes is relevant for contraceptive development and the provision of contraception services.

As far as we know, further systematic surveys of women’s attitudes towards changes in menstrual bleeding patterns as a result of contraceptive use have not been carried out since the WHO study conducted in the 1970s. However, various studies in Western countries have included aspects which may, when pieced together, give us a broad impression of current attitudes towards induced changes.9, 10, 11, 12, 13 Overall, the results suggest that changes in bleeding patterns caused by contraceptive use influence use decisions, although the general picture of women’s attitudes towards such changes remains patchy.

Hormone replacement therapy (HRT) used for the alleviation of climacteric complaints and prevention of postmenopausal osteoporosis and cardiovascular disease provides another example of medication that may change natural menstrual bleeding patterns and where such changes may influence decisions as to whether or not use is made of the treatment. Various authors have suggested that withdrawal bleeding during treatment deters women from the initial adoption and long term continuation of HRT.14, 15, 16, 17, 18 However, in this connection, a fuller understanding of women’s attitudes towards alterations in bleeding patterns, caused by HRT (in a perspective where the pattern naturally undergoes changes leading to postmenopausal amenorrhea) may also be relevant.

In the current study, we investigated preferred changes in the current menstrual bleeding pattern and attitudes towards changes in bleeding patterns caused by oral contraceptives (OC) and HRT in relation to reproductive status: adolescence, middle reproductive age, premenopause, and postmenopause. It was hypothesized that the younger reproductive status groups were likely to prefer regular, monthly cycles (dislike of irregular bleeding, fewer bleeding episodes per year, and amenorrhea), whereas the preference would shift toward absence of bleeding in the older groups. Secondly, we studied the extent to which OC and HRT are willingly employed by women to change their menstrual bleeding pattern, ie, to postpone bleeding or to control irregular, painful, or protracted bleeding.