Menstrual Suppression
Menstrual Suppression
Menstrual Suppression
net/publication/312429046
Article in The International Journal of Travel Medicine and Global Health · November 2016
DOI: 10.21859/ijtmgh-040405
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Corresponding Author: Majid Kazemi, Ph.D., Associate Professor of Surgical Nursing, School of Nursing, Rafsanjan
University of Medical Sciences, Rafsanjan, Iran. Tel: 03434255900; Fax: 03434258497; Email: [email protected]
Received September 3, 2016; Accepted October 20, 2016; Online Published December 5, 2016
Abstract
Introduction: The pilgrimage to Ka’beh (God’s house in Mecca) is a special opportunity in the life of most Muslims. Female
pilgrims try to postpone menstruation during the pilgrimage by taking hormonal medicines. However, women are seen in this
disorder. This paper aimed to determine the frequency of menstrual disorders and related factors among female pilgrims of Umrah
Mufradah in 2012.
Methods: This study was a descriptive type, the population of which comprised 400 female Iranian pilgrims aged 15-50 years who
were selected through random cluster sampling from Umrah caravans. Data was collected with a questionnaire developed by
the researchers that contained questions about menstrual disorders. The questionnaire was distributed among participants at their
hotels three days prior to their return to Iran.
Results: Among all the participants, 98.7% of them reported taking pills to suppress menstruation. Of this group, 74.7% successfully
prevented menstruation, 26% reported spotting, and 11.6% reported menstruation. There was no significant difference between
consumption of medicine and factors such as marital status, city, and educational background of the individuals. Participants
reported that spotting and menstruation caused them to experience stress and anxiety when performing Umrah rituals.
Conclusion: Experiencing menstrual disorders during pilgrimage can be stressful for pilgrims. To reduce such problems, counseling
sessions on menstruation postponement as part of the justification classes before departing for Hajj and compiling an equal and
coordinated nationwide protocol seem necessary.
Keywords: Menstrual, Oral contraceptives, Hajj pilgrims
Citation: Dandehbor W, Kazemi M, Salehi Shahrbabaki MH, et al. Menstrual suppression using oral contraceptives by female Hajj pilgrims. Int J
Travel Med Glob Health. 2016;4(4):111-114. doi:10.21859/ijtmgh-040405.
Copyright © 2016 The International Journal of Travel Medicine and Global Health. This is an open-access article distributed under the terms of the
Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.
Dandehbor et al
impediments to religion, is regarded as a special case and has % of them were single, and 80.8 % were married. The results
its own side effects and problems.5 Usually, women who are indicated that 53.2% were housewives, 44.7% had a bachelor’s
willing to use this method of prevention have not taken these degree or higher, and 2% of them were illiterate.
medicines before and are more likely to experience more side Results indicated that 98.7% of participants reported taking
effects. The emotional effects of contraceptive pills can be birth control pills to suppress menstruation, and 74.7% of
worse than their physical effects.6 The inefficiency of these them reported successfully preventing it. The average number
medicines in delaying menstruation appears mainly in the of pills used per day was 1.13 ± 0.45. The average start time for
form of spotting during consumption and can endanger the taking medicine before menstruation was 10.37 ± 9.7; 51.5%
main philosophy of consumption, to remove impediments of participants received consulted regarding the pills, and
to religion, and cause stress and other problems for the 19.9% of them had no consultation at all before the pilgrimage.
consumers. Some studies have investigated the consumption Consultation was received by 42.4% of participants one week,
of these medicines, and spotting while on the medicine 14.7% two weeks, 6.8% three weeks, and 36.7% more than
has been reported as a main complaint of pilgrims.2,7 Some 21 days prior to departing for Hajj. The average time before
women who use contraceptive pills during their pilgrimage departure for counseling was 22.23 ± 23.95 days (Table 1).
experience side effects. The most important and most Despite taking medicine to postpone menstruation, 26% of
commonly occurring side effect of the contraceptive pill is the participants reported spotting. Spotting was more frequent
spotting, which can lead to anxiety and depression. in participants aged 25-45 years than participants under the
Based on informal reports of menstrual disorders among age of 25 years or over 45 years. Statistically, the differences
pilgrims in Mecca, the current study aimed to determine were significant at P = 0.03 (Table 2). The average start time
the prevalence of menstrual disorders and related factors in for spotting was on the eleventh day of the menstrual cycle
Mufradah pilgrims in 2012. (11 ± 11.88). Also, 11.6% of the individuals taking medicine
to postpone menstruation reported menstruation. To obviate and spotting. Since contraceptive pills have a low amount of
spotting, 74.6% had referred to a doctor; of those individuals, estrogen in them, a low dose of conjugated estrogen is easily
61.6% reported their spotting was obviated and 27.9% used to alleviate the problem of spotting. Furthermore, with
reported increasing the dose of the medicine to obviate this the low dose of conjugated estrogen, the user is not disposed
problem. to the side effects of the higher hormone dosage.
Among the participants, 41% of those who consumed In a study by Sulak et al on 318 patients, they found that the
medicine experienced at least one medicinal side effect, pills decrease the symptoms of PMS in 13%, hypermenorrhea
mostly sickness and vomiting. 19% and headache 35%.10 Other studies which applied extended
There was no significant difference between menstruation and continuous regimens for preventing menstruation reported
delay and individuals’ educational background; however, the a high and variable prevalence of spotting and bleeding;
rate of medicine consumption was higher among persons however, these unwanted side effects were eliminated after a
holding a college degree (Table 3). There was no significant few cycles. A high prevalence of side effects was reported in
difference at P ˃ 0.05 between menstruation delay and factors women who used contraceptive pills for the first time.
such as marital status and the dispatch city in Iran. There was Ghorashi et al reported the occurrence rates of spotting
a significant difference between the consumption of medicine and menstrual bleeding in Hajj pilgrims in 2000 as 13.6% and
and the age category; fewer participants over the age of 45 2.1%, respectively.11 The low occurrence of these side effects
years took medicine than the others. in the study of Ghorashi et al compared with the results of the
Qualitative analysis of the open-ended questions showed present study can be attributed to the high dose of the pills
that spotting and menstruation were reported as stressful for taken by participants. In the study of Ghorashi et al, about
participants in performing Umrah rituals. Some participants 20% of the individuals took HD pills from the beginning, and
reported menstruation as causing feelings of their visit to the the others took two LD pills simultaneously.
Ka’beh being rejected by God and expressed experiencing In the present study, more than half of the individuals aged
great stress and anxiety. over 45 years had used hormonal medicines to postpone
menstruation. An increase in the age of the user increased
Discussion the side effects of the contraceptive pills.8 Moreover, most of
Results of the current study indicated that 74.7% of the the middle-aged women in this study suffered from diseases
female pilgrims successfully prevented menstruation during like diabetes or hypertension, both of which can endanger
their pilgrimage to the Ka’beh (God’s house in Mecca), and the consumption of contraceptive pills. Therefore, special
most of them reported using contraceptive pills to prevent it. training and care for postponing menstruation, such as the
Currently, the long-term use of contraceptive pills to decrease use of non-estrogenic pills, should be allocated to this group.
the occurrence of menstruation has been of great interest to Statistically, there was no significant difference between
researchers and women of reproductive age. Large numbers the start time for taking pills and the occurrence of spotting.
of women from all over the world prefer to take contraceptive Therefore, those women who had a delayed start in taking pills
pills to prevent menstruation for many days.5,8 during their menstrual cycle did not report the occurrence
Despite taking pills, 26% of the pilgrims participating in the of spotting any more than those who started taking the
current study experienced spotting and 11.6% menstruated. pill on the fifth day of their menstrual cycle. Furthermore,
The average start time for spotting was on the eleventh day Ghorashi et al found no significant difference between these
of the menstrual cycle. Spotting is a common side effect of two variables. It can be concluded that the delay in starting
contraceptive pills, even in the common 21-day method medicine consumption did not create additional problems for
of using them.9 Most cases of spotting in this study can be the users. This will be helpful for those who tend to decrease
attributed to the short interval between starting medication the consumption of the pill for different reasons. Therefore,
decreasing the number of pills can help decrease their side Research Highlights
effects.7
About 20% of the participants in this study who had used What Is Already Known?
menstruation postponement methods had received no It is already known the side effects of taking contraceptive
counseling on the use of medicine before starting consumption. pills for menstrual suppression and their failures are
From those who reported receiving counseling, more than considerable and cause pilgrims to feel much stress and
60% reported receiving counseling a short time (three inconvenience. This review elaborates on the effects of
weeks or less) before the pilgrimage. It should be noted that contraceptive pills on travelers.
unadvised use of contraceptive pills among those who are at a
What This Study Adds?
high risk can be dangerous or even deadly. Furthermore, the
The results of the current study suggest that the traditional
unadvised use of contraceptive pills can lead to inappropriate
approach of using contraceptive pills to suppress
consumption, the possibility of increased side effects, and a
menstruation should be replaced with the consumption of
lack of necessary instruction on how to cope with side effects
progestin-only pills, such as megestrol pills. It is essential
such as spotting. Therefore, it is suggested that counseling be
that pilgrims be advised about the possible side effects
taken into account in justification classes.
of the pills and the necessity of having them during the
It is recommended that justification classes be held duly
pilgrimage.
and more than one month before the pilgrimage to allow
women to make better decisions about how to postpone
menstruation.
The most common side effect of taking contraceptive pills regarding preventive measures of communicable diseases among
Hajj pilgrims at the entry point in Western Saudi Arabia. Saudi
noted in this study was vomiting, which is a prevalent side Med J. 2011;32(11):1161-1167.
effect of contraceptive pills.12 Because of the short period of 2. Al-Ghamdi SM, Akbar HO, Qari YA, Fathaldin OA, Al-Rashed RS.
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The relation between short-term oral contraceptive consumption
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disappointing, and problematic for them.14 To reduce such M, et al. Diseases pattern among patients attending Holy Mosque
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nationwide protocol seem necessary.15 6. Burkman RT. Oral contraceptives current status. Clin Obstet
Gynecol. 2001;44(1):62-72. doi:10.1097/00003081-200103000-
Conclusion 00010.
7. Madani TA, Ghabrah TM, Al-Hedaithy MA, et al. Causes of
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All authors contributed significantly toward this study. 10. Sulak PJ, Kuehl TJ, Ortiz M, Shull BL. Acceptance of altering the
standard 21-day/7day oral contraceptive regimen to delay menses
Conflict of Interest Disclosures and reduce hormone withdrawal symptoms. Am J Obstet Gynecol.
2002;186(6):1142-1149.
None declared. 11. Ghorashi Z, Taleghani F, Shafiee M. Failure and side effects of
contraceptive pills used for postponement of menstrual bleeding
Ethical Approval in Hajj Pilgrims of Kerman (2000). JSSU. 2005;12(4):65-70.
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Ijaiya MA. Menstrual suppression among female Nigerian pilgrims
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