Volume 77, Number 7

Menstrual manipulation: Options for suppressing the cycle

1. A 15-year-old girl has periods every 21 to 24 days (confirmed on her daily calendar) and is on the swim team, planning to compete throughout high school and perhaps in college. Menarche was at age 12. She gets some cramps, managed mainly with ibuprofen. She is not sexually active and has no plans for sex any time soon. Physical examination reveals a well-developed, well-nourished girl, weight 135 lbs, height 5'5". Which of the following recommendations is false?

1. She should avoid hormonal therapy because it leads to weight gain, which would interfere with her athletic performance
2. Hormonal therapy with a 28-day cycle would reduce the frequency of her menses
3. Hormonal therapy with an extended cycle would reduce the frequency of her menses
4. A vaginal ring would reduce the frequency of her menses
5. A levonorgestrel-containing intrauterine device may reduce the frequency of her menses