Obstet Gynecol. 2022 Sep 1;140(3):528-541. doi: 10.1097/AOG.0000000000004899.
The purpose of this document is to review currently available management options, general principles, and counseling approaches for reproductive-aged patients requesting menstrual suppression. It includes considerations for unique populations, including adolescents, patients with physical or cognitive disabilities or both, and those with limited access to health care. Gynecologists should be familiar with the use of hormonal therapy for menstrual suppression (including combined oral contraceptive pills, combined hormonal patches, vaginal rings, progestin-only pills, depot medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine device, and the etonogestrel implant). Approaches to counseling should be individualized based on patient preferences and goals, average treatment effectiveness, and contraindications or risk factors for adverse events. Counseling regarding the choice of hormonal medication for menstrual suppression should be approached with the utmost respect for patient autonomy and be free of coercion. Complete amenorrhea may be difficult to achieve; thus, obstetrician-gynecologists and other clinicians should counsel patients and caregivers, if applicable, about realistic expectations.
本文件旨在回顾目前可供生殖年龄患者请求闭经时使用的管理选择、一般原则和咨询方法。它包括对特殊人群的考虑，包括青少年、身体或认知障碍或两者兼有以及获得医疗保健机会有限的患者。妇科医生应熟悉激素治疗闭经的用途（包括复方口服避孕药、联合激素贴片、阴道环、孕激素仅避孕药、醋酸甲羟孕酮长效注射剂、左炔诺孕酮宫内节育器和依托孕烯植入剂）。咨询方法应根据患者的偏好和目标、平均治疗效果以及不良反应的禁忌症或危险因素进行个体化。在选择用于闭经的激素药物时，应充分尊重患者自主权，避免强制。完全闭经可能难以实现；因此，妇产科医生和其他临床医生应告知患者和护理人员（如适用）有关现实期望。
