Hormonal treatment of oligomenorrhea

[Blue Frog]

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In a young woman with irregular menstrual periods due to physiologic reasons (athleticism/being underweight/stress) what is the reasoning for putting her on oral contraceptives? I was once under the impression it had to do with osteoporosis, but I have read that oral contraceptives don't actually help to prevent it as was originally thought. Is this true? Do they need to be on oral contraceptives...and if so, under what circumstances (how infrequent/irregular do periods need to be)?

Also, if these women want another form of contraception (has trouble remembering to take the pill, has side effects from the pill, or wants better contraception) can they use other forms such as an IUD? (or do they need something cyclical and/or estrogen-containing)

 

[tiredmom]

My understanding is that the underlying reason for the OCPs in these young women is to prevent endometrial hyperplasia that occurs with the fewer menstrual cycles. You don't get as much as with PCOS, but it does occur. Estrogen does help some with bone density, so you can't fully discount it.

As far as another form of contraception, I think you definately DON'T want to put an IUD in a young woman (especially a teen), since it's primary means of interfering with conception is the damage it does to the endometrium. That damage isn't really reversible, so you wouldn't put an IUD in someone who has plans for future fertility. There are other forms of birth control that don't require everyday activity, such as the vaginal ring or the weekly patch.

 

[Blue Frog]

Thanks for the reply. Regarding the prevention of endometrial hyperplasia (and ultimately endometrial cancer) I believe you are correct.

However, I want to correct you on the use of IUDs in young women in general. It is certainly possible to use IUDs in young women and teens. Recent research has shown that it does not contribute to infertility. Years ago one particular IUD (Dakron?) was associated with PID and has since been taken off the market. Subsequent studies showed that current IUDs were associated with PID only when the patient was at high risk for STDs. Even more recently research shows that IUD do not increase PID even in these cases. (The only condition of which I am not certain is if there is a transient increase in PID immediately after insertion) Further semi-recent studies showed a small association of infertility (case control studies) with women who previously used IUDs, but the most recent studies show no increased risk.

On further thought, I would imagine that if, in fact, endometrial cancer, is the primary reason for putting an oligomenorrheic young woman on oral contraceptives, I would imagine an IUD would be would be an excellent choice for those who have contraindications to oral contraceptives.

Comments or disputes appreciated...

 

[manleyjb]

It was my understanding as well that the new IUDs do not contribute to the damage they once did. However, we do not usually put them in teens as they are contraindicated in patients with multiple sexual partners and past h/o PID. They have also been known to come out in teens due to a non-stretched uterus as well as be more uncomfortable. I think the ideal patient is one who has had at least one child, is in a monogamous relationship, no h/o PID or any other condition that would predispose them to an ectopic pregnancy.