Abstract
Introduction:
Research on Filipino-American contraceptive use is limited. We aimed to gauge beliefs and attitudes in this population regarding menstrual suppression through contraception.
Methods:
In this cross-sectional study, a modified version of a validated survey tool was administered through REDCap to a purposive convenience sample of 95 participants from California community organizations. The inclusion criteria were female, Filipino-American, aged between 18 and 55, and able to understand English and/or Filipino, the Philippine national language. Eligible participants consented before participation.
Results:
Most participants (70%) believed that contraceptive-induced amenorrhea (CIA) was harmful, and over half (56%) would not consider CIA. Chi-square analysis revealed that Philippine-born respondents were significantly more likely to avoid CIA than American-born respondents. Older age of immigration was associated with CIA avoidance.
Discussion:
Overall avoidance of CIA was observed among Filipino-American women (FAW), particularly those of migrant backgrounds. Future research and policy should aim to mitigate such reproductive health disparities.
Introduction
Amenorrhea is defined as the lack of menstruation. Beginning in the mid-1960s, the availability of steroid hormones made it possible to induce amenorrhea as a means of relieving menstruation-related symptoms such as heavy bleeding (Jahanfar et al., 2024). With increased access to contraceptives, more individuals around the globe have been able to manipulate their menstrual cycles, particularly by extending their oral contraceptive pill regimens (DeMaria et al., 2019; Nappi et al., 2018). Clinically, these extended cycles have had minimal negative health outcomes. Nevertheless, menstruation continues to be viewed as a marker of health, fertility, and normality across many cultures around the globe, as well as a practical sign of nonpregnancy (Mackenzie et al., 2020). A review by Polis et al. (2018) reported considerable variability in women’s views and responses to contraceptive-induced menstrual bleeding changes (CIMBCs) across the globe, noting that amenorrhea was most acceptable in the Americas and Europe. Other studies have shown that most women generally dislike their menstrual cycle (Kvalem et al., 2024) and would consider the use of a contraceptive that induced amenorrhea (Edelman et al., 2007). However, sexual and reproductive health (SRH) research notably lacks representative sample sizes from racial minorities, namely Asian American-Pacific Islander (AAPI) groups (Heyrana et al., 2023). SRH studies to date primarily report aggregated data for AAPI subgroups, although disparities in various metrics and health risks have been noted (Yi et al., 2022). For example, while AAPI adolescents are less likely to become pregnant or contract the human immunodeficiency virus, these lower sexual health risks are not uniform among AAPI ethnic groups (Chung et al., 2007; Heyrana et al., 2023). Accounting for these variations and differences is integral to forming successful culturally sensitive health programs and policies (Javier et al., 2010).
Filipino-Americans are the second-largest AAPI subgroup in the United States (U.S.) and the third-largest racial group in the state of California. Weitz et al. (2001) identified a higher rate of adolescent pregnancies in Filipinos (6%) than in other AAPI subgroups in California, including Vietnamese (4.4%), Korean (1.3%), and Chinese (0.8%); however, no more recent reports have reevaluated data on these disparities. Analyzing data from 2015 to 2016: California Health and Interview Survey, Xie et al. (2024) found that Filipino-American women (FAW) were less likely to use contraception compared to non-Hispanic White women, suggesting that lower contraceptive use may contribute to elevated adolescent pregnancy risk in this population. Another study attributed this higher adolescent pregnancy risk to minimal parent–adolescent communication and higher acculturation, which impaired the transmission of values potentially integral for adolescent sexual health (Chung et al., 2007). Overall, the influence of ethnicity and culture on Filipino-American SRH remains underexplored (Javier et al., 2010; Nagtalon-Ramos et al., 2022). No studies have gauged the influence of amenorrhea on contraceptive decision-making and comfort in contraceptive use among FAW. Given this scarcity in the literature and the dominance of the Roman Catholic Church in influencing not only Philippine social attitudes toward contraception, abortion, and premarital sex but also regional and national policies (Perez et al., 2022), more research on Filipino-American SRH is imperative. In this exploratory cross-sectional study, we utilized an anonymous, self-administered survey to gauge current perceptions surrounding menstruation, contraception, and contraceptive-induced amenorrhea (CIA) among reproductive-aged FAW. This study was conducted and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. When the term “women” is used, we refer to reproductively capable individuals. The goal was to assess how many individuals would consider using a contraceptive method that induced amenorrhea, as well as to gauge how ethnic, cultural, and demographic factors relate to beliefs and attitudes regarding bleeding and its frequency, the significance of or need for a regular bleed, contraceptive methods in general, and CIA.
Methods
Research Design
This Institutional Review Board (IRB)-exempt cross-sectional study builds on a University of California, Irvine (UCI) School of Medicine amenorrhea study, which gauged the menstrual and contraceptive preferences among English- and Spanish-speaking women in the United States (Masini et al., 2025). The study employed a correlational, cross-sectional survey design. This methodology is often used when seeking unique information regarding attitudes, beliefs, and self-reported behaviors, particularly in the context of informing health decisions and policymakers (Santesso et al., 2020).
Setting and Sample
Local Filipino-American populations in the cities of Norwalk, Cerritos, and Irvine were accessible to the Southern California-based research team; thus, survey distribution was focused on these enclaves between November 2023 and March 2024. Following inquiries for approval, flyers were placed in Filipino-owned establishments like cafés. When possible, the research coordinator actively recruited and assisted individuals to inform them of the study. The survey was also disseminated with the support of student-run, Filipino cultural organizations at UCI to promote the study to student members. Purposive sampling was used. Inclusion criteria were female, Filipino-American, aged between 18 and 55 years old, and literate in English and/or Filipino. Exclusion criteria were menopausal, unable to become pregnant or currently pregnant, or not English- or Filipino-speaking. Participants could choose to participate. An online gift card amounting to $5 USD was offered as an incentive for survey completion and given to those who chose to optionally provide an email address anonymously via the survey. The survey took about ten minutes to complete.
Data Collection and Instrument
We used a modified version of a validated survey first developed by Glasier et al. (2003). They conducted pilot testing with participant feedback for face and content validity. Edelman et al. (2007) made minor modifications to the questionnaire to tailor it for women seeking care in the United States. Our research team adapted the survey used by Edelman et al. (2007) to assess FAW’s cultural backgrounds. Three questions were added regarding whether participants self-identified as Filipino/Filipino-American, participants’ country of birth, and age of immigration to the United States. The 37-item survey consisted of questions on demographics, gynecological history, contraceptive use and attitudes, views toward menstruation, attitudes toward amenorrhea, and attitudes toward contraception that may cause amenorrhea. Questions were formatted as open-ended, multiple-choice, or Likert-type scale items. The survey was translated into Filipino, the Philippine national language, administered via REDCap software electronic data capture tools (Harris et al., 2009), and piloted with four native Filipino speakers. Oral feedback was used to support face and content validity, and a minor wording change was made to enhance linguistic accuracy (choosing to use the colloquial term “birth control” over the less frequently used Filipino translation of “pagkontrol ng panganganak”). Findings from the pilot study were excluded from the final participant sample and data analysis. In the questionnaire, the adjective “important”/“mahalaga” was used to avoid positive or negative bias in responders. During data analysis, importance was interpreted as a positive due to its inherent value to the responder. Surveys were administered through promotional materials (flyers and online presentation slides) with QR codes that directly provided the REDCap survey links in English and Filipino.
Data Analysis
Bivariate analyses using chi-square tests, or Fisher’s exact test when appropriate, were performed to assess associations between demographic variables and acceptance of CIA. When analyzing responses to whether participants desired using a contraceptive method that induced amenorrhea, a decision was made to combine the answers to “no” and “undecided” to distinguish between participants with a higher preference for CIA and participants with greater reluctance or avoidance toward CIA. A multivariate logistic regression model was also used to evaluate factors associated with preference for CIA; afterwards, a stepwise model selection was performed to select significant factors with both significance level of entry and stay at .30. Adjusted odds ratios for each covariate were then generated from the final post-selection model. Bivariate analyses were conducted via JMP, Version 17 (SAS Institute Inc., Cary, NC, 1989–2023), whereas multivariate analyses were performed via SAS 9.4 (SAS Institute Inc., Cary, NC). Statistical significance was set at p < .05, using two-tailed tests when relevant.
Ethical Considerations
This study underwent the Exempt Self-Determination Process under the UCI IRB. No identifiable information was collected from the participants; thus, the research protocol met the criteria for classification as exempt research and received an official confirmation of exemption from the UCI IRB. Completion of the self-administered survey implied subject consent, as stated in the introductory text of the survey.
Results
General Characteristics
Overall, 115 surveys were administered. Surveys were classified as largely incomplete if respondents did not provide complete responses beyond the first two of the five survey sections (n = 19); these responses were excluded from analysis. Another survey (n = 1) was excluded because the participant was currently pregnant. Partially completed surveys were those in which respondents provided complete data for the first three sections but did not complete the final two sections (n = 7); these responses were retained for analyses involving the completed sections. Consequently, 95 surveys were included in the analysis. There were 84 (four partially completed) English surveys, while 11 (three partially completed) were Filipino surveys. Nearly all participants self-identified as Filipino/Filipino-American; all of those who did not self-identify as Filipino/Filipino-American were born in the Philippines (Table 1). A slight majority were born in the Philippines, while just under half were born in the United States. Among Philippine-born respondents, most began living in the United States as children, with slightly fewer arriving as adults or young adults. A vast majority of all participants were aged between 18 and 25, followed by those aged between 26 and 35 and those aged 36 or older (Table 1). A minority were married. Nearly all identified as Asian, although some identified as American Indian, Native Hawaiian, or Pacific islander. More than four-fifths of participants identified as Christian, with the remainder reporting no religious affiliation. A large majority had some college education or higher.
Cultural and Demographic Background.
Filipino/Filipino-American backgrounds and demographic characteristics of survey respondents from 2023 to 2024 (N = 88 – 95) a .
Change in sample size due to survey non-completion. Questions regarding demographic background were placed in the survey’s final section.
Beliefs and Preferences on Contraception and Menstruation
Approximately half of our sample was not using a hormonal contraceptive at the time of the survey (51%). Most said that they do not like having monthly menses (75%), with 65% preferring to have a less-than-monthly period or never. Most indicated that avoiding pregnancy (88%) and heavy bleeding (66%) were important factors in choosing a contraceptive; only 45% said that skipping their period was important to them. A vast majority (70%) believed that CIA was harmful. Three-fourths of participants (75%) had never used the oral contraceptive pill, patch, or ring to postpone their period, while 80% had never used a contraceptive that stopped their periods. Over half (56%) responded that they would not consider using a contraceptive that induced amenorrhea, even if menses and fertility returned upon ceasing contraceptive use.
Associations With Perceived Harm and Acceptability of Contraceptive-Induced Amenorrhea
As expected, bivariate chi-square analysis revealed that participants who believed CIA to be harmful were significantly less likely to consider using a contraceptive that induced amenorrhea (p = .0177). However, no other significant associations were found between participants’ perceived harm from CIA and other survey responses pertaining to menses- and contraceptive-related views, such as their contentment with their menses (p = .6008); use of contraception to postpone or stop their periods (p = .3354); or preference for a monthly or less-than-monthly menses (p = .4693). Participants were significantly more likely to consider using a contraceptive that induced amenorrhea when they preferred a less-than-monthly menses (p = .0004), were utilizing some hormonal method of contraception at the time of the survey (p = .0086), were discontent with their menses (p = .0130), had previously used a contraceptive to postpone their menses (p = .0175), or had previously used a contraceptive which stopped their menses (p = .0302). No significant associations were found between preference for CIA and education (p = .6407) or religion (p = .0596). Similarly, no significant associations were found between the perceived harm of CIA and education (p = .9306) or religion (p = .0781). However, significant associations were noted between preference for CIA and country of birth (p = .0014) and between preference for CIA and age of immigration to the United States among Philippine-born respondents (p = .0032); specifically, being born in the Philippines and immigrating to the United States at older ages were associated with avoidance of CIA. Multivariate logistic modeling showed that Philippine-born respondents who immigrated to the United States as young adults or older had lower odds of having a preference for CIA (aOR = .12, 95% CI = [.03, 0.48], p = .0028). When controlling for covariates, participants who had used any method of birth control in the previous year had higher odds of having a preference for CIA (aOR = 2.97, 95% CI = [1.13, 7.84], p = .0275).
Discussion
This study aimed to evaluate beliefs and preferences regarding menses, contraception, and menstrual suppression through contraception, and to assess how cultural and demographic factors may be associated with these attitudes among reproductive-aged FAW. Our findings are consistent with prior studies in and outside the United States, which found that most women of different regional and cultural backgrounds dislike their menses due to its associated symptoms, discomfort, and inconvenience (Andrist et al., 2004; Chrisler et al., 2015; Kvalem et al., 2024). When asked about their preferred menstrual frequency, most also said that they would prefer to have a less-than-monthly period or no period at all. Nevertheless, a majority (56%) of our survey respondents indicated that they would not consider using a contraceptive method that induced amenorrhea. This finding is similar to that of a recent UCI School of Medicine study on predominantly Hispanic women from Southern California, in which 57% of respondents would not consider a contraceptive that induced amenorrhea (Masini et al., 2025). Although their sample was more likely to be older or married, the majority in our populations identified as Christian, had some college education or more, were not using a hormonal contraceptive at the time of the survey, and reported not liking monthly menses. No significant associations were also found between preference for CIA and education or religion. In contrast, a separate study in the United States comparing menstruation preferences in non-Hispanic Black-American and White-American women found that a majority of participants would consider the use of birth control that induced amenorrhea, although significantly fewer Black than White participants said they would (Edelman et al., 2007). In that study, most respondents also reported disliking monthly menses (69%), with White women, divorcees, and women with short cycles being more likely to consider CIA; strong correlations between race, study location (Oregon or Georgia), religion, and education were also found. Together, these findings suggest that intersecting cultural, religious, and structural factors may shape preferences surrounding CIA beyond individual attitudes.
The SRH and contraceptive use of FAW, in particular, are understudied and overlooked (Javier et al., 2010; Nagtalon-Ramos et al., 2022). Our study found that within the past year of taking the survey, 49% of our respondents had used any form of birth control. This aligns with data from the 2015–2016 California Health and Interview Survey, which showed that 45% of Filipino women aged between 18 and 44 used contraceptives (Xie et al., 2024). Along with Korean and Vietnamese women, Filipino women were found to be less likely to use contraceptives overall in comparison to non-Hispanic White women and California women in general. This lower contraceptive use may be a contributing factor to the higher rate of adolescent pregnancies previously noted for Filipino-Americans relative to other AAPI populations (Weitz et al., 2001). The 2024 study showed that foreign-born Asian American women who have resided in the United States for shorter periods are less likely to use effective birth control methods, an observation attributed to persistent cultural influences following cross-continental migration (Xie et al., 2024). This pattern implies that American-born FAW or Philippine-born FAW who have lived longer in the United States may be more likely to use contraceptives. Although Xie et al. (2024) reported a positive correlation between acculturation and overall contraceptive use among FAW, other studies demonstrate that the interplay of culture, religion, and other traditional values may continually shape reproductive health knowledge and access within the Filipino-American diaspora. To illustrate, investigations by Chung et al. (2007) and Nagtalon-Ramos et al. (2022) noted a lack of SRH knowledge and increased susceptibility to misinformation among young adult FAW, patterns linked to minimal parent–adolescent communication on sexual health and the heavy influence of more conservative Filipino values. Given that only 22% of our study population was married, it is important to note the additional context of stigmatization surrounding premarital sex. Nagtalon-Ramos et al. (2022) describe the deeply rooted Catholic beliefs of purity, hiya (shame), amor propio (self-respect), and pakikisama (social harmony), cultural norms that have been shown to limit intergenerational discussions, education, and service utilization regarding reproductive health due to concerns about their perceived endorsement of sex. Consistent with this, our findings show complexity in acculturation-related patterns of contraceptive use. With specific regard to contraceptives that induce amenorrhea, the majority of respondents in our study (56%) reported that they would not consider their use. This preference was significantly associated with contraceptive nonuse in the preceding year, the perceived harm of CIA, Philippines as the country of birth, and older age of immigration to the United States. Notably, neither education level nor religious affiliation was significantly associated with preference for, or perceived harm from, CIA. Collectively, these findings indicate that the acceptability of contraceptive methods, particularly those which alter menstrual patterns, may remain influenced by culturally embedded beliefs, even among individuals with higher exposure to U.S. reproductive health norms.
Concerns about the safety of amenorrhea induced by contraception may stem from traditional beliefs about menstruation, which may remain prevalent in minority groups like Filipino-Americans even with acculturation. In line with this interpretation, a large majority of our respondents (70%) indicated that they believed CIA to be bodily harmful, with no significant differences found between participants of different religions, education levels, or responses regarding their menses- and contraceptive-related views, such as preference for a monthly or less-than-monthly menses. Although findings show that most individuals are discontent with their menses and prefer a less frequent bleeding cycle, reduced menstrual bleeding is commonly perceived to be associated with negative health outcomes in different regions around the globe (Szarewski & Moeller, 2013). In addition to citing the reassurance provided by a regular bleeding cycle as a sign of nonpregnancy, studies from countries such as Brazil found that many, including U.S. minority adolescents, viewed the suppression of menses as unnatural (“A cross-cultural study of menstruation,” 1981; Clark et al., 2006; Hillard, 2014). Beliefs that menstruation is necessary for fertility and eliminating “bad blood” are commonly found in opposition to CIA (Glasier et al., 2003; Mackenzie et al., 2020). Moreover, menarche in the Philippines has traditionally been recognized through ritual practices, including face washing to prevent acne and jumping to promote growth, which may foster more positive attitudes toward menstruation by marking the transition to womanhood and fertility (Evans, 2023). Nevertheless, findings today assure the safety of CIMBCs. Long-standing research has shown that contraceptives can be administered efficaciously and safely to relieve negative symptoms and disorders associated with menstrual bleeding (Fiala et al., 2017; Nappi et al., 2018). Importantly, the specific use of extended hormonal contraceptive regimens to suppress menstruation has not been shown to produce any substantial adverse effects (DeMaria et al., 2019; Hillard, 2014). Although these misconceptions have been largely negated in the United States, investigations into existing discrepancies on the basis of race, ethnicity, or culture are minimal (Polis et al., 2018). Amenorrhea may contribute to lower overall contraceptive use among FAW, with factors such as limited SRH knowledge, misinformation, poor parent–adolescent communication, and traditional values potentially reinforcing this association (Chung et al., 2007; Nagtalon-Ramos et al., 2022). However, it is worth noting that at the time they took the survey, just under half (49%) of our respondents were using a birth control method in the past year, and 80% had never before used birth control that stopped their periods. These findings suggest that limited direct experience with CIA may be contributing to uncertainty or its negative perceptions among FAW, though further investigation is needed to identify the key influencing factors.
Given the strong influence of culture within the Filipino-American community, it is valuable to consider how the Philippines’ historically restrictive reproductive health environment may continue to shape persistent cultural norms and stigmas. This cultural legacy may help explain the relatively lower rate of contraceptive use and perceived harm of CIA observed among members of the Filipino diaspora, despite the broader reproductive freedoms and access available in the United States (Xie et al., 2024). In the Philippines, where about 80% of the population identify as Roman Catholic, access to contraception and other SRH services remains severely limited (Perez et al., 2022). This has been attributed to a combination of religious, political, and socioeconomic factors that impede Filipino women’s reproductive autonomy. Abortion is restricted and criminalized under all circumstances, with no explicit legal exceptions for cases involving high-risk pregnancies, rape, or incest (Hussain & Finer, 2013; Perez et al., 2022). Contraceptive access is also weakly supported by both the national and local governments, which have previously opposed and even banned the public provision of contraceptives in favor of natural family planning methods (Hussain & Finer, 2013; Perez et al., 2022). The inadequate large-scale delivery of education on sexuality and contraception, as well as societal stigma rooted in prevailing national religious values, further exacerbate disparities in SRH outcomes among Filipino women (Hussain & Finer, 2013; Perez et al., 2022). These issues disproportionately affect impoverished individuals, particularly those in geographically isolated and disadvantaged areas, who are especially vulnerable to pregnancy-related health risks, including those arising from unsafe abortions and lack of postabortion care. Bearak et al. (2022) estimated rates of pregnancy and abortion across 150 countries and territories from 2015 to 2019, and found that approximately 51% of all pregnancies in the Philippines were unintended and that 51% of these unintended pregnancies ended in abortion. Consequently, around 1,000 Filipino women die each year from postabortion complications (Perez et al., 2022). It is critical that health care providers and policymakers consider these sociopolitical and cultural influences to deliver SRH services and shape health policies aimed at the Filipino-American population. Future SRH research, policies, patient-provider communications, and other interventions should be tailored to address misunderstandings, with the particular susceptibility of certain subgroups in mind.
Limitations/Strengths
This study has numerous limitations. Its small sample size of convenience does not allow for conclusions made from mainly Southern Californian respondents to be generalized to the larger Filipino-American population. Participants were also mainly recruited through university student organizations, and thus most were currently enrolled in college or were college graduates. The student’s access to technology, social groups, health services, and other resources afforded by institutions of higher education may produce perspectives that are not representative of FAW from different educational backgrounds. A strength of this study is that it is the first to gauge the knowledge, preferences, and attitudes regarding contraceptive-induced amenorrhea among FAW in the United States. In addition, the survey was offered in both English and Filipino, allowing responses to be collected in spite of a language barrier.
Implications
Our findings underscore the need for culturally sensitive, community-focused measures in patient education and clinician‒patient communication to better understand the beliefs and reasons that contribute to the perceived harm of CIA while also addressing barriers to adequate SRH knowledge and health services within this population. Given the safety and benefits of amenorrhea induced by contraceptive use in relieving menstrual symptoms, mitigating misconceptions and knowledge gaps will inform more individuals of the choices and options surrounding CIA and help improve their overall quality of life. Future studies may seek to better understand the specific cultural and demographic factors in play, including age and time of immigration into the United States among Philippine-born individuals, and use a more nationally representative sample of FAW. The implementation and impacts of tailored interventions in health and educational policies may then be assessed for improvement in awareness of and knowledge regarding contraceptive-induced amenorrhea.
Conclusion
Like most women from diverse ethnic and regional backgrounds, most in our population of FAW were reluctant to consider using a contraceptive method that induces amenorrhea. This was despite a prevailing dislike for menstruation and its associated symptoms, with many women also believing that CIA was harmful. Participants who were born in the Philippines, particularly those who immigrated to the United States at an older age, were significantly more likely to avoid CIA than those born in the United States.
Footnotes
Acknowledgements
The authors would like to thank Jenny Chang, principal statistician at UCI, for her assistance with data analysis, and the Undergraduate Research Opportunities Program at UCI for their funding support.
Author Contributions
RD developed the conceptual idea of focusing on a cultural group; modified the survey methodology; collected, analyzed, and interpreted all survey respondent data; and drafted, reviewed, and edited the manuscript. IM and JP conceived the research focus on contraceptive-induced amenorrhea, developed the original framework of survey methodology, and verified the analytical methods used. HTB supervised the project and its overall direction, planning, and findings. All authors provided critical feedback and helped shape the research, analysis, and manuscript.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by the Undergraduate Research Opportunities Program at the University of California, Irvine.
Ethical Approval
This study is exempt from research and did not require review from the UC Irvine Institutional Review Board.
Participant Consent
The participants were able to access the survey through posted flyers and brochures and thus chose to participate. Oral/implied consent was obtained from participants who were approached by the student researcher and agreed to participate in the survey.
Consent to Participate
Completion of the self-administered survey implied subject consent, as stated in the introductory text of the survey.
Consent for Publication
No identifiable information was collected from the participants, and therefore, informed consent was not necessary for publication.
Data Availability
All the data gathered and analyzed during this study are included in this published article.