(53) Examining Menstrual Suppression Method Choice and Continuation Rates in Adolescents with Disabilities

Background: Menstrual manipulation in adolescents with disabilities is commonly used to assist with menstrual-related behavioral, emotional and hygiene concerns. While the medication options for menstrual suppression have continued to expand and provide satisfactory results, there is a paucity of studies that have evaluated whether there is a preferred method stratified by type of disability, and the continuance rates of the initial method selected in this particular population.

Methods: This was an IRB approved retrospective chart review of patients seen at our Pediatric and Adolescent Gynecology clinic by a single provider between 2018 and 2023. Our inclusion criteria were adolescents with a physical or cognitive disability who were seen for menstrual suppression. We used ICD-10 codes to identify charts for review. Exclusion criteria were patients who did not have an identified disability, or who were receiving contraception solely for pregnancy prevention. SAS was used to analyze our data. Our primary objective was evaluating choice of method for suppression stratified by disability type. Our secondary objective was evaluating retention rate on based chosen method.

Results: 86 patients met inclusion criteria. There was no difference in choice of method based on age, race, or ethnicity. Patients with cognitive disabilities were more likely to initiate progesterone only pills (POP) (p=0.03). There was no statistically significant difference between initial method choice for patients with physical disabilities (p=0.43). Patients who started with the hormonal intrauterine device (IUD) were most likely to continue on that method at 1 year (95%), whereas patients who chose the subdermal implant or the patch had the lowest continuance rates at 1 year (25%). The most common reason for changing methods overall was unsatisfactory bleeding profile (55%). Most patients who opted to change their initial method switched to the hormonal IUD.

Conclusions: Although menstrual suppression is often sought after for patients with a variety of disabilities, little data exists to help inform patients of preferred methods based on type of disability and continuance rates. Our study showed that patients with cognitive disabilities were more likely to choose POP as their initial method. Patients who chose the IUD were more likely to stay on that method at 1 year. Our numbers were too small to analyze differences between specific diagnoses within the cognitive and physical disability categories; so future research could include a multi-institutional study to achieve larger numbers for better data analysis.