Perimenopausal contraception

Abstract

Purpose of review Perimenopause is a time of reduced fertility, and yet unintended pregnancies can occur making comprehensive contraceptive counseling essential for these women. Concern over potential contraceptive risks has unnecessarily limited access and use of certain hormonal methods in this population. This review summarizes the available data on the use and effectiveness of contraceptive options during perimenopause. Recent findings All contraceptive options may be appropriate during perimenopause and no method is contraindicated based on age alone. Combined hormonal contraception has the added benefit of relieving perimenopausal symptoms including controlling menstrual irregularities. Progestin-only methods have the advantage of being taken either alone or in combination with estrogen replacement therapy to address both perimenopausal symptoms and contraceptive needs. Nonhormonal options exist for those wishing to avoid hormonal methods. Summary Extensive contraceptive options are available for perimenopausal women as they transition into menopause. Consideration of patient preference, medical co-morbidities, and perimenopausal symptoms will allow women to use the option that best serves her needs.

Use of hormonal contraceptives in perimenopause: A systematic review

“…All contraceptive options may be appropriate during perimenopause as age alone is not a contraindication. 23 Specifically, with the limited number of studies and treatment comparisons available, LNG-IUD with low-dose menopausal estrogen therapy had positive results for the management of disruptive perimenopausal symptoms and long-term outcomes, as well as a lower risk of adverse events compared with other hormonal contraceptive options. Additionally, continuation rates are highest for LNG-IUD compared with other hormonal contraceptive methods in perimenopausal women.…”

Menopause: A Global Perspective and Clinical Guide for Practice

“…Despite a decrease in fertility as women transition through perimenopause, normal and ovulatory menstrual cycles can occur right up until the FMP. Contraception should be continued until age 55 in women who wish to avoid pregnancy 11,12…”

“…In depot-medroxyprogesterone acetate users, FSH levels are not usually affected and women ages 50 to 55 years old can check FSH on the day of injection and repeated 13 weeks later before the next injection. If both levels are >30 IU/L depot-medroxyprogesterone acetate can be discontinued 11,18,22…”

“…False-negative results can occur and patients may need a longer hormone free interval for accurate results 18,23. All methods of contraception can be stopped at age 55 with no testing 1,11,13…”

“…If both levels are > 30 IU/L depot-medroxyprogesterone acetate can be discontinued. 11,18,22 Combined hormonal contraception users are more challenging since FSH is suppressed. Women aged 50 and older can stop their combined hormonal contraception and use a back-up method.…”