#2bleedornot2bleed: results from the European study ISY (Inconvenience due to women'S monthlY bleeding)

Objectives: For many women, monthly bleeding is painful, inconvenient and affecting everyday life. To assess the level of inconvenience associated with monthly bleeding, determine how many women would prefer less frequent bleeding, and what would motivate this choice. Method: A 15-min quantitative online survey was conducted in 2015 among 5728 women from 18 to 45 years old in 12 European countries (Austria, Belgium, Czech Republic, France, Germany, Hungary, Italy, Latvia, the Netherlands, Poland, Portugal and Spain). Among the participants, 2739 used a combined hormonal contraceptive (Group CHC) and 2989 a non-hormonal contraceptive (excluding copper intrauterine devices) or no contraceptive (Group no-HC). The relationship between the participant's profile, the contraceptive used, the menstrual period pattern and the preferred bleeding frequency was investigated. Each participant gave written informed consent. Results: Age, education, professional activity and number of previous pregnancies were the only significant differences between the two groups. The menstrual period was significantly longer (5.0 days vs. 4.6 days), heavier (15% heavy menstrual flow vs. 7%), and with more symptoms (5.9 vs. 5.3) in Group no-HC than in Group CHC (p < 0.0001). Pelvic pain, bloating/swelling, mood swing, and irritability were reported in more than half of the women in each group. Given the choice, 61% of women in Group CHC and 58% in Group no-HC would opt for longer intervals between periods than once every month. Lifestyle reasons, such as sexuality, social life, work and sporting activities, were key factors for this decision. Conclusions: This survey showed that the majority of women want less than once monthly menstrual periods, with a frequency ranging from once every three months to no periods at all. This can be explained by the desire to avoiding the unpleasant aspects of menstruation and its negative impact on private and professional life.