title: Use of hormonal contraceptives to control menstrual bleeding: attitudes and practice of Brazilian gynecologists.
abstract: BACKGROUND
  The purpose of this study was to assess the attitudes and prescribing practices of Brazilian obstetricians and gynecologists regarding use of contraceptive methods to interfere with menstruation and/or induce amenorrhea.
  
  
  METHODS
  We undertook a nationwide survey of Brazilian obstetricians and gynecologists selected using a computer-generated randomization system. Participants completed a questionnaire on prescription of contraceptives and extended/continuous regimens of combined oral contraceptives (COCs).
  
  
  RESULTS
  In total, 79.2% of Brazilian obstetricians and gynecologists reported that 20%-40% of their patients consulted them for menstrual-related complaints and 26%-34% of the gynecologists reported that 21%-40% of their patients consulted them for reduction in the intensity, frequency, and/or duration of menstrual bleeding. Overall, 93% stated that medically induced amenorrhea represents no risk to women's health and 82.5% said that they prescribed contraceptives to control menstruation or induce amenorrhea. The contraceptives most commonly prescribed were extended-cycle 24/4 or 26/2 COC regimens and the levonorgestrel-releasing intrauterine system. Poisson regression analysis showed that Brazilian obstetricians and gynecologists prescribing contraceptives to control menstruation or induce amenorrhea consider extended-use or continuous-use COC regimens to be effective for both indications (prevalence ratio 1.23 [95% confidence interval 1.09-1.40] and prevalence ratio 1.28 [95% confidence interval 1.13-1.46], respectively). They also prescribed COCs with an interval of 24/4 or 26/2 to control bleeding patterns (prevalence ratio 1.10 [95% confidence interval 1.01-1.21]).
  
  
  CONCLUSIONS
  Brazilian obstetricians and gynecologists were favorably disposed toward prescribing extended-use or continuous-use COC regimens for control of menstrual bleeding or to induce amenorrhea on patient demand.
authors.affiliation: Center for Research in Reproductive Health (CEMICAMP), São Paulo, Brazil.
authors.forename: María Y
authors.initials: MY
authors.lastname: Makuch
authors.affiliation: Center for Research in Reproductive Health (CEMICAMP), São Paulo, Brazil.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: D Osis
authors.affiliation: Center for Research in Reproductive Health (CEMICAMP), São Paulo, Brazil ; Prof Dr José Aristodemo Pinotti Women's Hospital, University of Campinas, São Paulo, Brazil.
authors.forename: Karla Simonia
authors.initials: KS
authors.lastname: de Pádua
authors.affiliation: Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, and National Institute of Hormones and Women's Health, Campinas, São Paulo, Brazil.
authors.forename: Luis
authors.initials: L
authors.lastname: Bahamondes
keywords: Brazil; gynecologists; hormonal contraceptives; induced amenorrhea; menstruation