title: Menstrual suppression using oral contraceptives: survey of deployed female aviation personnel.
abstract: BACKGROUND
  Increasing numbers of women perform aviation duties in the combat flight environment. Oral contraceptive pills (OCPs) afford numerous health and operational benefits, including prevention of anemia and suddenly incapacitating conditions, as well as menstrual suppression when taken continuously. Until now, the use of OCPs in the combat flight environment has not been examined.
  
  
  METHODS
  An anonymous, voluntary questionnaire was distributed to 62 female U.S. Army aviation personnel who had recently deployed in support of combat flight operations to characterize continuous OCP use and perceived barriers to this practice, as well as to determine associations with menstrual burden.
  
  
  RESULTS
  There were 81% (N=50) of the women who had personal experiences using OCPs and 93% (N=58) were aware that continuous use can suppress menstruation. For deployment, 66% (N=41) desired menstrual suppression, yet only 33% (N=20) reported any OCP use. Even fewer (15%; N=10) reported using continuously. Of the women who did not use OCPs continuously, 35% had insufficient knowledge about OCPs and 44% of women reported difficulty in remembering to take a daily pill. Continuous OCP users were more compliant (P = 0.019), reported less spotting (P = 0.007) and fewer unexpected menstrual cycles (P = 0.03) than conventional OCP users. A trend toward reduced cramping was noted (P = 0.064). Most women (60%) desired standardized entry-level education about menstrual suppression through OCPs.
  
  
  CONCLUSIONS
  The use of continuous OCPs is low in deployed women with aviation-related duties, yet a majority desires menstrual suppression. Continuous OCP use in this setting is associated with significantly improved compliance and significant reductions in specific menstrual burdens. Entry-level education is desirable and may reduce barriers to continuous OCP use by addressing risks, side effects, and daily pill adherence strategies. Flight surgeons should provide further education and consider continuous OCP dosing in the austere environment of combat flight.
authors.affiliation: Naval Operational Medicine Institute, NAS Pensacola, Pensacola, FL, USA. dunford.powell@us.army.mil
authors.forename: Nicole
authors.initials: N
authors.lastname: Powell-Dunford
authors.forename: Amanda S
authors.initials: AS
authors.lastname: Cuda
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Moore
authors.forename: Mark S
authors.initials: MS
authors.lastname: Crago
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Deuster
mesh_terms: D000328:Adult; D000337:Aerospace Medicine; D001359:Aviation; D003278:Contraceptives, Oral, Hormonal / Q000008:administration & dosage*; D003625:Data Collection; D004334:Drug Administration Schedule; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008598:Menstruation / Q000187:drug effects*; D008889:Military Personnel; D011293:Premenstrual Syndrome / Q000517:prevention & control; D055815:Young Adult
chemical_list: D003278:Contraceptives, Oral, Hormonal