Health Care Provider Hormonal Recommendations for Treatment of Menstrual Cycle-related Problems - A Vignette-based Study
Rui Chen
Internal Medicine Resident II, Department of Medicine, University of British Columbia, Canada.
Fatemeh Bejaei
Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC, Canada.
Shan Yi
Clinical Pharmacist, Health Link BC.
Tabassum Vali
Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC, Canada.
Jerilynn C. Prior *
Centre for Menstrual Cycle and Ovulation Research, Vancouver, BC, Canada and Endocrinology and Metabolism, Department of Medicine, University of British Columbia, Canada and School of Population and Public Health, University of British Columbia, Canada and Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.
*Author to whom correspondence should be addressed.
Abstract
Background: Combined hormonal contraceptives (CHC) are recommended for “non-contraceptive benefits” for menstrual cycle-related problems. But no evidence-based consensus exists. Our purpose was to assess the clinical choices of health care providers (HCP: pharmacists, physicians, nurses) for menstrual cycle-related scenarios.
Methods: A 1-page questionnaire was provided to continuing professional education attendees at events across Canada. They suggested treatments for four common clinical scenarios each involving a different menstrual cycle-related problem. Each case was followed by five to six choices. All potential options included CHC and cyclic progesterone (P4) or medroxyprogesterone (MPA); HCP could choose multiple options.
Results: CHC was recommended by 84% of HCP for at least one of four scenarios; 64% chose cyclic P4/MPA at least once. For teenage menorrhagia, 63% chose CHC, 23% cyclic P4/MPA and only 31% ibuprofen. For the 35 year-old smoker with polycystic ovary syndrome (PCOS), 55% discontinued CHC, but 22% suggested switching to higher-dose anti-androgen CHC; 23% chose cyclic MPA, 32% spironolactone and 14% metformin. For a premenopausal fragility fracture, 34% recommended CHC and only 5% cyclic MPA; 17% chose a contraindicated aminobisphosphonate. For perimenopausal VMS, 10% chose CHC, 34% cyclic P4, 21% cyclic MPA.
Conclusion: There are significant variations among HCP disciplines for treatment of menstrual cycle-related problems. Contraindications and disadvantages of CHC-based therapies in these scenarios seem to not be recognized by HCP. Evidences for progesterone-based therapies have not been translated into current clinical practice. Few HCP suggested evidence-based non-hormonal treatments. Efforts are needed to translate research-based, physiological menstrual cycle treatments into safe and effective clinical practice.
Keywords: Menstrual-cycle disturbances, cycle-related problems, clinical practice, Combined Hormonal Contraceptives (CHC), cyclic progesterone therapy, evidence-based treatment, non-hormonal treatments.