Breakthrough bleeding (BTB) with contraceptive pill use in deployed female
military personnel – a deployment health issue?
A. C. Schmidt (1), H. Yasmin (2), C. Cox (1,2)
34 Field Hospital, Iraq (1); Department of Obstetrics and Gynaecology, New
Cross Hospital, Wolverhampton, UK (2)
Introduction and Aims: A significant number of female troops use a
contraceptive pill for cycle control, which is popular due to the difficulties
of maintaining hygiene in an austere environment. BTB rates may increase with
stress and illness, common causes being: missed pills, cervical disease,
infection, smoking and decreased absorption secondary to diarrhoea and vomiting.
This study was carried out to determine cycle control practices, to evaluate the
issue of BTB and its effects on the personal hygiene, health and quality of life
in deployed military women.
Methods: A questionnaire was undertaken of 100 females deployed to the
Persian Gulf with a British Field Hospital in May 2003. Methods of contraception/cycle
control, BTB patterns, obstetric and gynaecological history, incidence of
diarrhoea and vomiting, and the subjective effects of BTB on lifestyle and work
were explored.
Results: 52.7% of women on hormonal contraception reported BTB. Of
these, most were using a standard-dose, second-generation pill. 17.6% of pill
users discontinued their pill due to BTB. De novo menstrual irregularities were
also reported in personnel not using contraception. Pre-deployment menstrual
frequency was regular in 85% of women with new BTB. 25% of subjects with BTB had
previously returned abnormal cervical smears. 42.9% of women questioned reported
difficulties with personal hygiene, affecting quality of life and work.
Conclusion: BTB is a significant health issue for deployed women.
Further research is required to examine and improve: 1) Training of military
doctors and General Practitioners in screening, counselling and care of
deployable females; 2) Access to gynaecological investigations; 3) Management of
BTB on deployment, and; 4) Access to adequate hygiene facilities in the field.
