Menstrual Suppression for Combat Operations: Advantages of Oral Contraceptive Pills

Background: Increasing numbers of women are deployed to austere settings in which menstruation may impose logistical challenges. Minimal data exists about the use of oral contraceptive pills (OCPs) for menstrual suppression in this population. Post-deployment survey was undertaken to establish prevalence of continuous OCP use, perceived barriers, and associations with menstrual burden in a military population within the austere environment. Methods: Voluntary and anonymous 44-item questionnaire. Results: Of 500 women, 78% (n = 390) had personal experience using OCPs and 66% (n = 330) desired menstrual suppression. However, only 40% (n = 192) reported any OCP use and only 21% (n = 99) reported continuous use during deployment. Sixty-seven percent of women reported some difficulty in daily pill compliance and nearly half (45%) missed ≥1 pill per week in the austere setting. Continuous users were nearly twice as compliant as conventional users (p=.019) and compliant OCP users reported significantly less menstrual burden than noncompliant users (p=.017). Almost all women (85%) desired mandatory education about menstrual suppression through OCPs. Conclusion: Despite OCP experience and desire for amenorrhea, prevalence of extended cycle OCP use in this population is low. Extended OCPs users in the austere setting report improved compliance and reduced menstrual burden compared with conventional users. Education about OCPs is highly desirable for most military women and may benefit those in austere settings.