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Female astronauts are exposed to harsh conditions that make menstruation undesirable; in addition, pregnancy is contraindicated for many preflight training activities and for spaceflight itself. These authors conducted a systematic review to provide up-to-date, evidence-based information about options for menstrual suppression and contraception in female astronauts.
Based on results of terrestrial studies, the levonorgestrel intrauterine system and subdermal contraceptive implant were identified as highly effective choices that have the added advantage of minimizing “upmass” (feminine hygiene products and packaging that become trash).
Jain V and Wotring VE.Medically induced amenorrhea in female astronauts. npj Microgravity 2016 Apr 21; [e-pub]. (http://dx.doi.org/10.1038/npjmgrav.2016.8)
Comment
Although few of us provide healthcare for female astronauts, work environments in which menstruation is an advantage are highly uncommon. Moreover, despite the wide variety of therapeutic approaches to menstrual suppression, many teens continue to miss school because of uncontrolled menstrual cramps (NEJM JW Womens Health May 2016 and Obstet Gynecol 2016; 127:699). I reassure my patients that there's no “need to bleed” unless pregnancy is desired. I also encourage intrauterine and subdermal options for menstrual suppression even when women are not sexually active with men.