Menstrual cycle and fertility control are two important issues facing reproductive age women that impact unit readiness and deployment experience. The health and quality of women's lives could be markedly improved if all women received comprehensive education, had access to a full range of contraceptive options, and actually used one of these options. Comprehensive education combined with utilization of contraceptive methods has proven to allow women to effectively control their menstrual cycles, with implications for deployment health and the rate of unintended pregnancies. This combination of education and contraception has the potential to heighten unit readiness and resilience.
Contraception and education can play a significant role in the quality of life for active duty women. Lost duty days due to difficult menstrual cycles and unintended pregnancy impacts daily mission requirements, unit readiness and morale. It is important to provide education to servicewomen in order for them to understand all their options during deployment and their careers. Providing detailed contraception education at the right time and in the right venue can have a profound impact on women's lives and mission readiness.
Unintended pregnancy rates in the United States are as high as 50-65 percent, with the Army reporting the highest rates among the branches of service. Over half of these pregnancies occurred in women who were not using any method of contraception, and most of these women were young, married or cohabitating and have lower education levels. The negative consequences associated with unintended pregnancy are decreased mission readiness, unit cohesion and morale. Providing contraceptive education to women early in their careers can combat these high unintended pregnancy rates and provide some long-term options that will benefit the individual service member and the military.
Women suffer regularly with premenstrual syndrome, mood swings, cramping, and irregular bleeding with light and heavy days. Heavy days can be associated with anemia. For some, these symptoms result in lost duty days. Many women only have a basic understanding of their menstrual cycles. There is widespread stigma that contraception is solely for "birth control" and few understand the important role that contraception can play in menstrual regulation. Contraception has other uses that are not often discussed or recognized, such as menstrual cycle control or suppression, that can increase the quality of life for women. Menstrual cycle control is when a woman uses hormones to control the number of cycles that she has per year whether that means having a cycle every month, quarterly, or none at all.
Education
Education regarding the menstrual cycle and the variety of contraceptive options available to improve menstrual cycle control should be done as early as possible in the service member's military career. Education benefits both the individual by increasing health awareness and knowledge, and the Army by decreasing the number of missed work days due to menstrual illness and unintended pregnancies. A "menstrual wellness" refresher class should be offered whenever a unit is scheduled to deploy. According toArmy research, 74 percent of women deployed in support of OIF/OEF and Afghanistan reported that they did not receive information about menstrual cycle control prior to deployment. At a minimum, the class should review menstrual cycle control/suppression options and provide women with emergency contraception to take with them on deployment should they have unprotected/unplanned intercourse or experience a sexual assault. The Tricare Formulary offers 11 different options for emergency contraception. Check your local pharmacy for specific options available to you.
Deployment Options
A study of deployed women serving in Iraq finds that contraception use by active duty women averages 69 percent overall with a decrease in use during deployment to an average of 58 percent. Women who deploy assume that they will not be sexually active therefore they choose to not use contraception without realizing the other benefits like menstrual cycle control and suppression. There are concerns about side effects like nausea, weight gain, headache and abnormal bleeding. If women do use contraception, they tend tochoose more popular options like oral contraception. Oral contraception is not necessarily the best option during deployment. Limitations with this method include lack of availability and difficulty adhering to the daily regimen due to long shifts and mission
requirements.
Providers can help to overcome the issue of availability by prescribing enough packs to last the entire length of the deployment. Female Soldiers can then bring their own supply to theater. If the deployment is extended, the Soldier would have plenty of time to identify resources to refill their prescription. Nuvaring is an option that women choose because it only has to be changed once per month. The limitation with this option is it cannot be stored in temperatures above 86 degrees and it must be refrigerated for long-term storage.
Ortho-evra "the patch" is another option because it doesn't require daily dosing but weekly changing of the patch. Consideration of location of the deployment is important as many women have had difficulty with patch adherence in extreme temperatures resulting in discontinued use. Many women are aware that Depo-Provera, a long-acting injectable reversible contraceptive option can be very effective at decreasing or eliminating menstrual bleeding. Depo-Provera does have some downsides. It may cause weight gain which is not a desirable side-effect for many active duty women. It also has to be injected every 12-14 weeks, which may be a problem during deployments, when geographic location or mission requirements limit access to the medication.
Other long-term options, Long-Acting Reversible Contaception (LARC) include Nexplanon and intrauterine devices (IUD) such as Skyla and Mirena, are other excellent options for military women. Nexplanon is a single implantable rod that is placed in the non-dominant upper arm that lasts for three years. Intermenstrual bleeding is a common complaint by women in the first fewmonths of use so it should be placed well in advance of the deployment if possible. Skyla and Mirena are hormonal IUDs that are FDA approved for dysmenorrhea and menstrual suppression that last for 3 to 5 years respectively. Most women have several months to prepare for deployment,
offering an important window of opportunity for women to discuss the use of Depo-Provera or LARC prior to the deployment.
Related Links:
The Official Website of U.S. Army Medical Command
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