Contraception and family planning at the extreme of reproductive life – climacteric

Abstract

Menopause is an endocrine phenomenon characterized by gradual estrogen decline. This is a stage in a woman's life in which contraception is extremely important as the risks associated with pregnancy and childbirth increase, both maternal issues associated with higher incidence of comorbidities and issues related to fetal abnormalities, mitochondrial abnormalities, or genetic syndromes. On the other hand, there is a growing number of women who have postponed motherhood and need effective contraception, but without prolonging the return to fertility. Long-acting reversible contraceptives (LARCs), low-dose oral hormonal contraceptives and non-oral contraceptives are preferred. The levonorgestrel-releasing intrauterine system is a very good alternative that can maintain endometrial protection after menopause. Definitive methods such as tubal ligation and vasectomy are options for couples that already have their offspring. In this review, we present evidence for contraceptive indication and the effects of hormonal methods on climacteric including options for contraception, control of bleeding during perimenopause and of climacteric symptoms, as well as the transition from such methods to hormone therapy if indicated.

Low dose estrogen progestin pill is better than cyclical progestin as medical management of abnormal uterine bleeding due to ovulatory dysfunction in premenopausal women

“…Oral contraceptive pills ameliorate the vasomotor symptoms like menstrual migraine (headaches related to fall in estrogen) that affects more than 60 premenopausal women. [13][14][15] The hormonal contraceptives prevent bone demineralization and enhances bone mass density both of which provides protection against osteoporosis in postmenopausal women. 16 The incidence of endometrial ovarian and colorectal cancer peaks at premenopausal age and combined hormonal contraceptives reduces the risk of these cancers.…”

Climatério

“…Caso desejada, a anticoncepção deve ser individualizada, considerando comorbidades, contraindicações e adaptação da paciente. Na faixaetária correspondente ao climatério existem especificidades que se destacam na escolha dos métodos contraceptivos (DI BELLA et al, 2016;MINISTÉRIO DA SAÚDE, 2008).…”

Contraception During Perimenopause: Practical Guidance

“… 16 Therefore, in the fourth and fifth decades of life in women there is a noticeable incidence of adenomyosis, polyps and fibroids, which are possible organic causes of AUB. 17 Among the spectrum of perimenopausal uterine alterations, it is important to include endometrial hyperplasia, a condition that is characterised by morphological alterations in the ratio of endometrial glands/stroma. 18 This disease frequently occurs after forties and the risks cannot be underestimated.…”

“… 25 A reduction of vasomotor symptoms, such as hormone-related headaches or menstrual migraines, which occur in more than 60% of perimenopausal women, especially during a hormone-free interval (HFI). 17 , 25 , 26 Protection against bone loss via two mechanisms: preventing bone demineralisation, which is very important in this life-stage, and enhancing bone mineral density, even at low doses. 27 A reduction of endometrial, colorectal and ovarian cancer risk, close to their peak incidence.…”

“…A reduction of vasomotor symptoms, such as hormone-related headaches or menstrual migraines, which occur in more than 60% of perimenopausal women, especially during a hormone-free interval (HFI). 17 , 25 , 26 …”