What can I do to overcome patient resistance to continuous use of oral contraceptives (OCs)? So many women say it’s not natural.—SHERRY HILL, ARNP, Bothell, Wash.
When discussing menstrual suppression with patients (via either continuous OC use or a progestin [e.g., Mirena or Depo-Provera]), an explanation of the physiology can be helpful. Reassure patients that the uterus won’t be filled with months of menstrual blood; the lining simply won’t form as it used to. It may also be useful to discuss the physiology of normal menstruation. Explain that the period isn’t a mechanism for infection prevention or the removal of toxins from the body. Numerous medical studies have affirmed the safety of menstrual suppression (Obstet Gynecol Clin North Am. 2007;34:137-166). The Association of Reproductive Health Professionals (www.arhp.org) offers useful educational materials for clinicians and patients. Knowing that monthly menstruation is a historic anomaly can help to recast assumptions about what is natural and normal. Malcolm Gladwell’s article “John Rock’s Error” explains this history in fascinating detail. Ultimately, if a patient feels that a monthly withdrawal bleed suits her best, many OCs containing 21 active pills and seven inert pills are available.—Lisa Stern, APRN (138-2)