Menstrual Suppression Using Oral Contraceptives by Female Hajj Pilgrims

Healthy, safe and responsible: the modern female traveller

One-half of all travellers are women; yet, there is a distinct lack of detailed travel health knowledge on topics of unique relevance to women. While there is medical advice relating to stages in the female lifecycle, it neglects women-specific practical aspects despite their ability to harm travellers’ health and cause inconvenience. This paper discusses comprehensively three major aspects of travel as they relate to women. First, it suggests the management of personal hygiene, bodily functions, menstruation and sexual behaviour, and alerts to the limited knowledge on travel mental health issues.

Second, apart from travelling in a female body with its specific demands, being a woman requires special attention to safety and security. Within various travel contexts, women have many opportunities for minimising potential risks.

Finally, guided by travel medicine’s acknowledgment of its role in the concept of responsible travel, this article goes beyond the usual general statements and broad advice and offers detailed and practical suggestions on how the female traveller can contribute to the overall goal of minimising any potential harm to fellow humans and the natural environment. Recognising the scarcity of women-specific travel information, pathways to better education, and a range of suggestions for urgent research facilitate the provision of high-quality travel health care tailored specifically to women’s needs.

Norethindrone is superior to combined oral contraceptive pills in short-term delay of menses and onset of breakthrough bleeding: a randomized trial

Background

To determine whether oral norethindrone acetate is superior to combined oral contraceptives (OCP) in delaying menstruation and preventing breakthrough bleeding when started late in the cycle.

Methods

This article comprises of a case control study followed by a pilot randomized controlled study. In the first study, four women who presented late in their cycle and desired avoiding vaginal bleeding within 10 days before a wedding were started on norethindrone 5 mg three times daily and compared to age matched controls started on OCPs. Subsequently, a randomized controlled pilot study (n = 50) comparing OCPs to norethindrone for the retiming of menses was conducted. Percentage of women reporting spotting were compared with level of statistical significance set at p < 0.05.

Results

Of the norethindrone treated group, only 2 women (8%) reported spotting compared with 10 women (43%) in the control group (p < 0.01). Norethindrone recipients experienced significant weight gain, which resolved after cessation of therapy and had heavier withdrawal bleed (p < 0.04) when compared to controls. Patient satisfaction was significantly higher in the norethindrone group, with 80% willing to choose this method again. Time to conceive was significantly shorter in the norethindrone group (p < 0.03).

Conclusions

Norethindrone, begun on or before cycle day 12, is superior for women who desire to avoid breakthrough bleeding and maintain fertility when compared to OCPs. It is an ideal approach in patients presenting late in their cycle and who desire delaying menses as well as in circumstances when even minute amounts of breakthrough bleeding cannot be tolerated.

Trial registration

Clinicaltrials.gov NCT03594604, July 2018. Retrospectively registered.

Contraceptive Beliefs and Practices of American Muslim Women

Objective: To assess contraceptive beliefs and practices among American Muslim women residing in Southern California. Materials and Methods: English speaking Muslim women were approached in Southern California mosques and online and asked to participate in a survey about birth control. Primary outcome measures included the belief that Islam permitted use of contraceptives to prevent pregnancy, to treat menstrual disorders, and to suppress menstrual flow that would prevent attendance at religious rituals; personal contraceptive use was also assessed. Subgroup analysis investigated potential impacts of demographic variables. Results: The interview response rate was 88%. Among the convenience sample of 276 women, 64.4% were younger than 35 years of age, most were well educated, and had an above average income. Eighty percent of respondents believed that Islam allowed the use of contraception to prevent pregnancy, and 85.1% believed that it allowed for the treatment of menstrual disorders. Overall, 93.4% believed that Islam allowed the use of all reversible contraceptive methods, but 35% believed that Islam did not permit permanent contraceptive methods. Belief was related to higher income or educational level, headscarf use, and being Muslim from birth. Of the reproductive age sexually experienced participants, 96.5% reported ever using any contraceptive method. The most commonly ever-used methods included oral contraceptive pills (72.5%), male condoms (68.9%), coitus interruptus (39.9%), and intrauterine devices (21.2%). Conclusion: The vast majority of American Muslim women surveyed believe that their religion permits use of reversible contraceptive methods. They have used contraceptive methods at rates similar to other women in the United States.