Nav: Home

Menstruation in spaceflight: Options for astronauts

April 21, 2016

A new paper in the journal npj Microgravity explores the options for astronauts who want to prevent menstrual bleeding during their space missions. The paper, written by authors at King's College London and Baylor College of Medicine, reviews contraceptive devices available including those already used by military and aviation personnel, and calls for more research into the effect of hormone treatments on bone mineral loss in space.

Although full amenities are available should astronauts choose to menstruate in space, the practicalities of menstruating during pre-flight training or spaceflight can be challenging. For short duration missions, menstrual cycles can to be timed according to mission dates but for longer hauls, menstrual suppression is often preferred.

During long duration missions, astronauts have traditionally continuously taken the combined oral contraceptive (COC) pill to prevent menstrual flow. A three-year exploration class mission is predicted to require approximately 1,100 pills, whose packaging would add mass and disposal requirements for the flight.

Long acting reversible contraceptives (LARCs) such as IUDs and subdermal (beneath-the-skin) implants are also safe and reliable methods for this purpose but as of yet, have not been extensively used by astronauts. Opting for a LARC would however remove the upmass, packaging, waste and stability issues as a device could be inserted prior to a mission and replacement would not be required in-flight.

It is up to individuals to choose which method to use but LARCS appear to have a number of advantages for spaceflight, according to the paper's authors.

From an operational perspective, LARCs would not be expected to interfere with the ability of the astronaut to perform her tasks. There are no reports in the scientific literature suggesting high G loading experienced during launch or landing would damage a subdermal implant or shift the position of an IUD. However, consideration may need to be given as to whether the implant could rub or catch on specialist equipment or attire such as a diving suit or extra-vehicular activity suit.

The effect of hormone treatments on bone mineral density (BMD) is another issue for spaceflight, where astronauts lose bone at a much higher rate than on Earth. Previous studies have found a reduction in BMD with some contraception choices, namely the progestin only injection (DMPA), and whilst on earth these reductions are temporary, due to irreversible spaceflight related bone changes a treatment option which may impact BMD may not be advised. It is unknown whether taking the pill continuously would help protect against bone mineral loss. The authors call for further research to understand the impact of the COC in combination with microgravity, on bone mass density in women.

The paper concludes that astronauts should be provided with up-to-date, evidence-based information to make informed decisions about menstrual suppression if it is desired.

The uniqueness of spaceflight provides many challenges in conducting research, as the number of subjects required for clinical studies cannot be matched by the number of current active female astronauts. The authors suggest that combining pharmacological data from spaceflights with equivalent ground-based studies investigating menstrual suppression might provide the evidence required to trial LARCs during spaceflight.

Dr Varsha Jain, Visiting Researcher at the Centre of Human and Aerospace Physiological Sciences (CHAPS) at King's College London and NIHR Academic Clinical Fellow in Obstetrics and Gynaecology, said:

"Studies of women in the military have shown that many would like to suppress their menstrual flow during deployment, but only a proportion of them use the pill to do so; the majority of women surveyed also wanted more advice from the military to help them make the right choice.

"With more women going into space, we need to ensure they also have the most up-to-date information on reliable contraception and means of menstrual suppression. It is ultimately the woman's choice to suppress, but options should be available to her should she decide to do so."?

Dr Virginia Wotring, Assistant Professor at the Center for Space Medicine, Baylor College of Medicine, said:

"For any woman, choice of a contraceptive requires careful consideration of benefits and risks with respect to her lifestyle and needs. The spaceflight environment adds some extra complexity to the overall equation, and we want female crewmembers to be able to make well-informed choices for their missions. Because loss of bone mineral density is known to occur on spaceflight missions, we need more data regarding health effects, including bone health, with long-term use of hormone treatments not just for contraception (as most women use them), but also for the less-common use to suppress menses."
-end-
Notes to editors

For further information please contact Hannah Bransden, Press Officer at King's College London, on +44 (0)207 848 3840 or email hannah.bransden@kcl.ac.uk

'Medically Induced Amenorrhea in Female Astronauts' by Jain and Wotring is published in the journal Microgravity on Thursday 21 April at 11:00 EST/16:00 BST. DOI 10.1038/npjmgrav.2016.8. Once live, the paper can be accessed here: http://www.nature.com/articles/npjmgrav20168

For more information about King's College London, please visit King's in Brief.

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (http://www.nihr.ac.uk).

King's College London

Related Microgravity Articles:

Emergency medicine in space: Normal rules don't apply
Experts at this year's Euroanaesthesia congress in Geneva (June 3-5) will discuss the unusual and challenging problem of how to perform emergency medical procedures during space missions.
Why don't fish freeze to death in icy water?
Microgravity experiments revealed that supercooled water containing antifreeze glycoproteins accelerates and oscillates its ice crystal growth rate, contrary to what was expected.
Space station crew cultivates crystals for drug development
Crew members aboard the International Space Station will begin conducting research this week to improve the way we grow crystals on Earth.
Mutants in microgravity
A proof-of-concept investigation, Nanobiosym Genes, is sending two strains of Staphylococcus aureus bacteria to the International Space Station.
Stem cells seem speedier in space
Growing significant numbers of human stem cells in a short time could lead to new treatments for stroke and other diseases.
Orbital ATK Cygnus set to deliver research to space station
Orbital ATK is targeted to launch its Cygnus spacecraft into orbit for a resupply mission to the International Space Station March 24, 2017 from Cape Canaveral Air Force Station in Florida.
Keeping liquids off the wall
The Slosh Coating investigation tests using a liquid-repellant coating inside a container to control the movement of liquids in microgravity.
Keeping our cool in space
The Two-Phase Flow investigation looks at the heat transfer characteristics of how boiling liquids turn into vapor in microgravity.
Blast off: Stem cells from Mayo Clinic physician's lab launch into space
Today, the latest rocket launch from NASA's Kennedy Space Center in Cape Canaveral, Fla., included a payload of several samples of donated adult stem cells from a research laboratory at Mayo Clinic's Florida campus.
Russian-Japanese research helps understand the effects of microgravity on bone tissue
As is well-known, space flights bring with them a unique set of health hazards.

Related Microgravity Reading:

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Bias And Perception
How does bias distort our thinking, our listening, our beliefs... and even our search results? How can we fight it? This hour, TED speakers explore ideas about the unconscious biases that shape us. Guests include writer and broadcaster Yassmin Abdel-Magied, climatologist J. Marshall Shepherd, journalist Andreas Ekström, and experimental psychologist Tony Salvador.
Now Playing: Science for the People

#513 Dinosaur Tails
This week: dinosaurs! We're discussing dinosaur tails, bipedalism, paleontology public outreach, dinosaur MOOCs, and other neat dinosaur related things with Dr. Scott Persons from the University of Alberta, who is also the author of the book "Dinosaurs of the Alberta Badlands".