Menstrual Suppression

What is menstrual suppression?

A menstrual period, or menstruation, refers to the vaginal bleeding that occurs as part of a woman’s monthly cycle. Periods begin once a girl has reached puberty, usually between the ages of 11 and 15 and continue until a woman reaches menopause, around the age of 51. Menstruation is the body’s way of shedding the lining of the uterus, which passes through the vagina, along with menstrual blood.

Menstrual suppression is a treatment that uses medication to reduce or stop menstrual periods. Under the care of a doctor, this is a safe option for all girls, teens and young women once they have already had at least one menstrual period.

Who should consider menstrual suppression?

Any girl, teen or young woman with menstrual periods can consider using medication to safely reduce or stop their periods. Sometimes doctors suggest menstrual suppression for medical reasons like heavy periods, painful periods or endometriosis. Menstrual suppression can also help with other medical conditions that may get worse during menstrual periods such as headaches, seizures, postural orthostatic tachycardia syndrome (POTS) and chronic pain.

Young women with physical or developmental disabilities may prefer to not have periods if personal hygiene is difficult. Finally, some may choose to have fewer or no menstrual periods because it is their personal preference to not experience menstrual bleeding each month.

What tests are needed before starting menstrual suppression?

There are usually no tests needed before starting menstrual suppression. Your doctor will take a careful medical and gynecologic history before recommending or prescribing treatment. A pelvic exam is not needed before starting menstrual suppression.

Menstrual suppression takes time to regulate and stop menstrual bleeding. Unexpected bleeding is most common in the first three months but can continue for longer. At Children’s Hospital Colorado, we will continue to work with you until you are satisfied with your treatment.

What should I expect during menstrual suppression treatment?

There are many different options for menstrual suppression, and your doctor will work with you to find the best one based on your individual medical history. Most teens have no side effects or minimal side effects depending on which option they choose. Menstrual suppression typically takes 3 to 6 months before periods are stopped completely.

The hormonal medications used for menstrual suppression act on receptors located in the cells of the uterine lining to keep this lining thin. When the lining does not build up, it is safe to go without menstrual periods.

Menstrual suppression medications are known as hormonal therapies, and there are many ways these medications can be delivered, including a pill, skin patch, vaginal ring, injection or an implant. All these options contain progestin, which causes the lining of the uterus to grow thin so menstrual bleeding can be safely suppressed. The progestin-containing intrauterine device (IUD) is a way to deliver medication directly to the lining of the uterus.

Methods of menstrual suppression

Treatment choice	How to use	What to expect after the first 3-6 months
Pill	Take 1 pill every day	Lighter and regular periods Less cramping and less pain Clearer skin No weight gain Can be used in a certain way to have a period only every 4 months, or to have no periods at all
Vaginal ring	Change every month
Skin patch	Change every week
Depo-Provera	Shot every 3 months	Lighter or no periods after 6-9 months of use Less cramping and less pain May cause increased appetite
Progestin IUD	Doctor places inside the uterus; IUD works for 5 years	Lighter or no periods Less cramping and less pain No weight gain
Implant	Doctor places under skin of arm; implant works for 3 years	May have no periods or irregular bleeding Less cramping and less pain

What are the options for using an IUD for menstrual suppression?

The progestin-containing IUD is a common choice for menstrual suppression and there are two different options for how we can place it. The first and most common option is to insert it during a procedure in the office. For this type of insertion, your doctor would first perform a pelvic exam, then place the IUD inside the uterus. Before choosing to have an IUD placed in the clinic, we explain the IUD insertion procedure and let you decide whether you’re comfortable doing it this way. Patients usually experience some cramping and moderate discomfort during the procedure, and cramps may continue for several hours to follow.

Another option for IUD placement is to have it done while you are asleep, under anesthesia, in our procedure or operating room. Placing an IUD under anesthesia greatly reduces and usually eliminates any pain or cramps typically associated with the procedure done in the office. When the patient wakes up after the procedure, they may have some moderate cramping or none at all. A procedure to insert an IUD under anesthesia is scheduled for a specific date and time by our surgery scheduling team. With advance notice, we are often able to coordinate with other services, such as dental cleaning or MRI tests.

What should I expect after menstrual suppression treatment?

Menstrual suppression can be used for as long as desired. Many teens do continue to have difficult menstrual periods through their adult years, so it is important to discuss with your doctor before stopping treatment.

Using medication for menstrual suppression does not affect a woman’s ability to have a baby later. When a woman stops her medication, periods will return as they would if the treatment was never used.

Why choose us for menstrual suppression?

Our team at the Pediatric and Adolescent Gynecology Department has decades of experience providing options for menstrual suppression. We work with each patient to find the best option based on your medical concerns and other medical conditions.

Helpful resources

Learn more about various options for hormone therapy that can safely suppress menstrual bleeding.