What is menstrual suppression?
Some parents/caregivers worry about how their child or teen will deal with
menstruation (periods). Parents/caregivers may have concerns about how they will manage bleeding, pain and mood changes or if they will be able to use pads or tampons. Menstrual suppression uses medications to make periods more manageable and can help to address these common concerns.
Can someone's first period be prevented?
Some families ask about stopping periods before they start. This is not recommended for the following reasons:
- Some people have very few symptoms and will be able to manage their periods on their own.
- Starting medications before a first period may impact a person's overall growth.
Menstrual suppression decision aid
The decision aid tool below can help you work with your health-care practitioner to make informed decisions about managing your child’s or teen's menstrual periods. This tool will help you understand why some people may need help with their period, what options are available and which treatment may be best for your family. This tool can be used by children or teens and parents/caregivers.
Menstrual suppression decision aid tool
Common concerns about menstruation
Some families consider menstrual suppression to manage the following concerns.
Cramping
Monthly periods can be painful. Some people may have trouble communicating what they are feeling. Different behaviours, such as hitting their stomach, may be a clue that they are having pain. Children and teens may miss school or other activities because of pain.
Bleeding
Some people have heavy bleeding. This can cause them to feel weak or tired. Typically, a period comes once a month, but sometimes bleeding can be irregular or unpredictable.
Mood changes
Some people can have mood changes during their period. They can feel sad, angry or irritable. This can interfere with their daily activities.
Personal hygiene
Hygiene can be hard to manage for people who need help with bathing and toileting. They may not like to wear pads or tampons because they feel uncomfortable.
Seizure management
People with seizure disorders may have more seizures before their period, during their period or in between periods.
Pregnancy
Some people are sexually active and could become pregnant. Caregivers may be concerned about abuse and want to protect their child/teen from pregnancy.
Menstrual suppression options
Several options are available to help with menstrual suppression. It is important that both parents/caregivers and the child/teen be involved in making decisions about menstrual suppression. Working together will help find the best fit for your child or teen.
- Watch and wait
- Tranexamic acid
- Combined hormonal contraceptive pills
- Hormonal contraceptive patch
- Progestin-only pills
- Progestin-only injection
- Progestin-only intrauterine device (IUD)
- Progestin-only implant
- Surgery
Watch and wait
Some people may be able to manage their periods with some help from their caregivers and health-care practitioners. Over time, they may be able to learn self-care during their period. The amount of bleeding and cramping with each period can be decreased with medications such as non-steroidal anti-inflammatories (e.g., Advil) or acetaminophen (e.g., Tylenol). If these medications are not effective, you can discuss other options with your health-care practitioner.
Time period
There is no time limit for this option.
Benefits
- Medications can be used when needed, rather than taking a medication on a daily basis.
Drawbacks
- Your child/teen will continue to have a period each month. This option may not be recommended if their periods are heavy, painful or prevent them from participating in daily activities.
- This option does not prevent pregnancy.
- Using non-steroidal anti-inflammatory drugs over a long period of time can lead to gastrointestinal issues, including heartburn or stomach ulcers.
Tranexamic acid
Tranexamic acid is a medication that can be taken to help reduce heavy bleeding. It is not a hormone medicine.
Time period
This medication is taken two to three times a day on days when there is heavy menstrual bleeding.
Benefits
- This medication will help to reduce heavy bleeding.
- This medication can be taken with other types of menstrual suppression, such as hormone pills.
Drawbacks
- Your child/teen will continue to have a period each month.
- This medication will not help with painful periods.
- This option does not prevent pregnancy.
- For some people, this medication can cause nausea, vomiting and diarrhea. Some people may experience leg cramps or joint pain.
Combined hormonal contraceptive pill
Combined hormonal contraceptive pills contain estrogen and progesterone. There are many different brands available. One pill is taken every day. The medication can be crushed or given through a feeding tube.
Time period
This medication can be used in many different ways. Some people take this medication for 21 days and then take a sugar pill for seven days. Those seven days are when a period would come. Pills can also be taken every day for a longer period of time to decrease the number of periods a person has.
Benefits
- The pill makes periods regular with less bleeding and cramping.
- The pill can make skin healthier and reduce acne.
- The pill may help to prevent mood changes.
- The pill prevents pregnancy.
Drawbacks
- Children/teens (or their caregiver) have to remember to take/give the pill every day.
- Some people will have side effects from the pill including spotting, breast tenderness, nausea, vomiting and headaches. These symptoms get better with time.
- Taking the pill slightly increases the risk of blood clots in the legs and lungs. People who have a history of blood clots may not be able to use this medication.
- The pill can interfere with certain medical problems or medications.
Hormonal contraceptive patch
The contraceptive patch contains and delivers the hormones estrogen and progesterone through the skin. It is a small, waterproof patch that is placed on the skin, often on the arm, upper back, abdomen or buttock. It should be applied on or near the chest.
Time period
The patch is removed and replaced once a week. Some people will wear a patch for three weeks in a row and then have a week off for a period. The patch can also be worn for a longer period of time to decrease the number of periods a person has.
Benefits
- The patch makes periods regular and reduces bleeding and pain.
- The patch can make skin healthier and reduce acne.
- The patch may help to prevent mood changes associated with periods.
- The patch prevents pregnancy.
- The patch may be useful for people who cannot take medications by mouth (e.g., if they have difficulty swallowing).
Drawbacks
- Some people will have side effects from the patch including spotting, breast tenderness, nausea, vomiting and headaches. These symptoms get better with time.
- Some people do not like the feeling of wearing a patch on their skin and may remove it.
- The patch can sometimes make skin red or itchy. This may improve over time.
- Using the patch slightly increases the risk of blood clots in the legs and lungs. People who have a history of blood clots may not be able to use this medication.
- The patch may not work as well in people who weigh more than 90 kg (200 lbs). This is mainly important if it is being used to prevent pregnancy.
- The patch may interfere with some medications or medical problems.
Progestin-only pill
The progestin-only pill contains the hormone progesterone. The medication can be crushed and given through a feeding tube for people with difficulties taking pills.
Time period
The pill is taken daily. There are no days off.
Benefits
- This medication makes periods less painful.
- Many people will not have a period while using this medication.
- This medication is safe for people who cannot take estrogen.
- Some progestin-only pills protect against pregnancy.
Drawbacks
- Children/teens (or their caregiver) have to remember to take/give the pill every day.
- Some progestin-only pills need to be taken at the same exact time every day.
- Some people will have nausea or spotting when they start the medication. This may get better with time.
- Some people may feel more sad or irritable with this medication.
Progestin-only injection
A progestin-only injection is an injection that contains the hormone progesterone.
Time period
This injection is given by a health-care practitioner every 10 to 12 weeks.
Benefits
- After using this medication for one year, more than half of the people using it do not have a period.
- This medication is safe for people who cannot take estrogen.
- Progestin-only injections protect against pregnancy.
Drawbacks
- Some people may have irregular spotting when starting this medication.
- Some people may feel more sad or irritable with this medication.
- This medication usually lasts for three months. If someone experiences negative side effects, they may last for several months.
- While taking this medication, bone density may decrease. This is reversible once the medication is stopped. People using this medication should take vitamin D and calcium supplements.
- Some people may gain 1 to 2 kg (4 to 5 lbs) per year while using this medication. This can make physically caring for your child/teen more difficult.
- This option may not be right for people who have difficulties with injections.
Progestin-only intrauterine device (IUD)
An IUD is a small device that is placed inside the uterus by a doctor. It releases the hormone progesterone.
Time period
The device is replaced every five to seven years.
Benefits
- An IUD makes periods lighter and less painful. Nearly half of the people using it will not have a period.
- If the young person has bothersome side effects, the IUD can be taken out.
- IUDs protect against pregnancy.
Drawbacks
- Sometimes, an IUD can be inserted into the uterus in clinic. However, some people may require general anaesthesia for IUD insertion.
- Irregular bleeding and cramping are common for up to six months following insertion. This will improve over time.
- There is a very small risk the IUD can fall out or become embedded in the uterus.
- There is a slight risk of infection in the first month after insertion.
Progestin-only implant
The progestin-only implant is a small plastic rod that is placed under the skin of the arm by a doctor. It releases the hormone progesterone.
Time period
This implant lasts for three years.
Benefits
- The implant makes periods lighter and less painful.
- The implant is safe for people who cannot take estrogen.
- If your child/teen has bothersome side effects, the implant can be taken out.
- The implant protects against pregnancy.
Drawbacks
- After the implant is inserted, there may be bruising, tenderness and swelling of the arm.
- Some people may experience side effects such as headaches, breast tenderness, nausea and mood changes during the first few months after the implant is inserted. This may get better over time.
- The implant is inserted in the arm with a needle. This may not be the right option for people who have difficulties with needles.
Surgery
In most cases, your health-care practitioner can help manage periods with medicine. Some families ask about different options for surgery:
- Tubal ligation: A tubal ligation is a surgery that blocks or removes the fallopian tubes. This surgery prevents pregnancy but does not change periods. For this reason, this is not a good option for managing periods.
- Hysterectomy: A hysterectomy is a surgery that removes the uterus. This will stop periods, but a hysterectomy is a major surgery with potential risks, and it is not reversible.
Please talk to your health-care practitioner if you have any questions.