Success of Menstrual Suppression for Patients with Obstructive Müllerian Anomalies

Patients with obstructive Müllerian anomalies (OMAs) experience significant pain secondary to hematometrocolpos and often require menstrual suppression to achieve symptomatic pain control and to optimize timing before surgical intervention. Currently, there are limited data on menstrual suppression for these patients. We aimed to describe our institution's experience with the success of different menstrual suppression options for this population.

A retrospective cohort study of patients diagnosed with and treated for an OMA from 2012 to 2024 was performed at a tertiary care center. Exclusion criteria included imperforate hymens, those with surgical intervention at outside institutions, and patients lost to follow-up. Demographic characteristics, type of OMA, total time of menstrual suppression, and methods used were collected. The primary outcome was successful pain management of at least 3 months, with unsuccessful management defined as changes in therapy or proceeding with surgical management due to pain.

Forty-two patients were included. The mean age was 15.7 years, and patients had a variety of OMAs. Of the patients, 57.1% (24/42) began menstrual suppression before surgical intervention. Most patients on suppression (66.7%, 16/24) began taking a combined oral contraceptive (COC) pill: 45.8% (11/24) took a 30-mcg ethinyl estradiol (EE) pill, and 20.8% (5/24) took a 20-mcg EE pill. Almost half (41.6%, 10/24) of those on menstrual suppression did not have adequate pain control with their initial method. Of the patients, 87.5% (21/24) ultimately achieved successful pain management using a variety of methods, including 30-mcg EE COCs (9/21), 20-mcg EE COCs (2/21), gonadotropin release hormone (GnRH) agonist depot leuprolide (3/21), progestin-only pills (4/21), and 1 patient each using the medroxyprogesterone acetate injection and the combined estrogen-progestin patch.

Most patients who began menstrual suppression in this cohort took COC pills. Many patients reported effective suppression with COC pills containing 30 mcg of EE. Almost half of the patients reported poor pain control with the initial menstrual suppression method.