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Toag 5 1 34
The Obstetrician
& Gynaecologist
2003;5 134-7
Keywords
benefits,
elimination,
menstruation,
regulation,
symptoms.
Author details
Kelly Blanchard MSC, Program
Associate, Population Council, Po
Box 411744, Craighall 2024,
Johannesburg, South Africa. ernail:
kblanchardOpcjoburg.org.za
34
Health benefits
Regulating or stopping menstruation can
eliminate some health problems and has
potential health benefits. Combined oral
contraceptives are routinely prescribed to address
menstrual symptoms regardless of need for
contraception.'," Eliminating menstruation and
the associated changes in hormone levels can
alleviate mood swings, personality changes and
other complaints associated with premenstrual
syndrome (also sometimes referred to as
premenstrual tension).'.'." Continuous COC use
can also reduce menstruation-associated
symptoms among women using COCs in the
traditional 21/7 fashion."." In addition,
eliminating menstruation can prevent the
recurrence of catamenial conditions (such as
epilepsy and arthritis) that often worsen
cyclically, with the changes in hormone levels
associated with menstruation.' For example,
endometriosis symptoms are aggravated by
menstruation. Endometriosis is associated with
severe abdominal pain, pain during intercourse
and infertility. Clinicians have prescribed
continuous COC use as a treatment for
endometriosis for years."
Reducing nienses-associated blood loss can also
reduce anaemia. An estimated 30% of the
world's population are anaemic, including 20%
of regularly menstruating women in
industrialised countries.' For malnourished
women in developing countries in particular,
monthly menstruation can cause a dangerous
increase in anaemia. Finally, menstruation and
repeated ovulation are thought to be associated
with a number of reproductive cancers.'
Natural or optional?
Given this large body of evidence that
menstruation may be bad for women, as well as
inconvenient, why aren't more women choosing
not to menstruate? From the earliest days of
medicine menstruation has been seen as
'natural'- nature's treatment for the variety of ills
that affected women (including abdominal
cramps, depression and mood swings), which
today we understand are actually caused by the
hormonal changes leading up to menstruation.
The beneficial effects attributed to menstruation
were a large part of the rationalisation for the
harmful practice of bloodletting, performed on
patients for a wide range of ailments.' Even the
development of the oral contraceptive pill was
influenced by the idea that menstruation is
natural. John Rock, one of the original
developers of COG, was a devout Catholic and
wanted a method that worked by natural means.
He believed that the hormone progesterone
prevented ovulation and established the 'safe
period' and, therefore, hoped that taking this
hormone regularly would be accepted by the
Catholic Church as a natural contraceptive
method." If menses were eliminated it would be
clear that this method was not natural so he
designed the regimen with a pill-free week to
induce withdrawal bleeding to mimic menses.
There is no known medical indication for the
withdrawal bleed and, in fact, it is not a
menstrual period in the medical sense.
REVIEW
The Obstetrician
& Gynaecologist
2003;5:34-7
35
REVIEW
The Obstetrician
8!Gynaecoogist
2003;5:34-7
36
Conclusions
The Obstetrician
& Gynaecologist
2003;5:34-7
, 99
1 --
REVIEW
--
lo00
I95
-- 90
m--
200
--
--
-- 80
70
-,,g;L--------'-m
-50
-- 40
5 --- 30
50--
-- 20
-- 10
60
70
p 5 \+- .:5
,002
-- 2
Pretest
Probability
Likelihood
Ratio
Post-test
Probability
Endometrial disease
Endometrial cancer
References
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