Menstrual regulation in family planning services

Fertility control by means of menstrual regulation is discussed in the context of family planning programs. Its efficacy, efficiency, safety, cost effectiveness, and acceptability are evaluated. Menstrual regulation is the term applied to any treatment which is administered within 14 days of a missed menstrual period to ensure that a woman either is not pregnant or does not remain pregnant. Because pregnancy tests are not accurate at this stage of pregnancy, it cannot be reliably determined whether a woman is pregnant prior to the procedure. The most common method of treatment is vacuum aspiration using a small diameter, clear plastic, flexible cannula. Neither dilation of the cervix nor anesthesia is usually required. Curetting the uterus for delayed periods has been performed for at least a century under the guise of 'dry cupping' or diagnostic endometrial biopsy to investigate amenorrhea. Many physicians have also had the experience of missing the ovum and having a pregnancy continue. Unfortunately, because these procedures were performed under guises, their effectiveness and complication rates for use in women with amenorrhea are unknown. The first systematic studies of the practicability of menstrual regulation were initiated by the International Fertility Research Program in 1972. Menstrual regulation appears to be a safe, effective, and economical method of fertility control. Its increased safety compared to first trimester abortion establishes menstrual regulation by vacuum aspiraion for treatment of up to 14 days missed menstrual period as probably better medical practice than waiting to confirm the presence of a pregnancy. Because it is a postconceptive method, menstrual regulation has potential in family planning services both as a recruitment service and for the treatment of contraceptive failures. Its use as an only method of fertility control is being studied. The acceptance of this new family planning service will primarily depend on its availability, dissemination of information about the service, and the ability of women freely to avail themselves of the service without delay. Although long term effects of single and repeated use of menstrual regulation are not known, its immediate complications are few and it can be recommended as a useful addition to present fertility control methods in family planning programs.