Contraception for the perimenopausal woman

Abstract

Perimenopause, or the menopause transition, is a time in a woman's life that bridges her reproductive years through to the non-surgical cessation of ovulation, or menopause. For many women this time is one of changes: changes in gynecological issues, onset of symptoms not experienced in her youth and increasing risks for adverse medical conditions. Despite the clear changes that occur for many women during this time, one critical issue is frequently ignored, namely, that, until the onset of menopause, she is exposed to pregnancy if sexually active, and pregnancy for older reproductive women is fraught with considerable increases in morbidity and mortality compared to younger women. This paper will present a review of the reproductive issues of the perimenopause and interventions geared to preventing pregnancy and relieving menopause-related symptoms. As counseling remains a critical aspect in empowering women to make informed choices about their health care, this paper will present current evidence that will help clinicians provide accurate reproductive counseling to women in the menopause transition.

Use of Combined Oral Contraceptives in Perimenopausal Women

“…In general, menopause is defined as not having menstruation for 12 consecutive months, but women who take COCs may continue to show withdrawal bleeding even during menopause or become amenorrheic even though they are not in menopause, and thus, menopause may not be determined by the status or duration of amenorrhea. 9 One method to check for menopause while taking COCs is to discontinue use for 2–3 months at the age of 50 years and observe whether menstruation returns. However, this method is not suitable when using COCs not only for symptom control purposes but for contraceptive purpose.…”

“…These additional benefits may promote an improved quality of life in perimenopausal women. However, a majority of middle-aged women believe that they should not take COCs because taking COCs at an older age may be dangerous, 9 and in some cases, even healthcare providers are hesitant to prescribe COCs to middle-aged women because of potential negative health effects. The objective of the present review is to examine the recommendations of the Centers for Disease Control and Prevention (CDC) on the use of COCs in perimenopausal women while exploring the benefits and risks of COC use in perimenopausal women.…”

Protective activity and safety of multiphase combined oral contraceptive based on natural estrogens in women of advanced age

“…Дополнительным «бонусом» к терапии нарушений менструального цикла при использовании КОК является эффективное лечение вазомоторных симптомов [22]. Хотя имеется ограниченное количество данных, исследования показывают, что 90% женщин испытывают улучшение состояния по сравнению с 40% не использующих КОК [23]. Причем женщины, которые принимают КОК в режиме 21/7, могут иметь возврат симптомов в дни, свободные от приема гормональных таблеток, в отличие от режима 26/2 или пролонгированных (непрерывный или гибкий) режимов [22].…”

Unintended pregnancy: a framework for prevention and options for midlife women in the US

“…In the United States, birth rates for women up to age 44 years have been trending upward since the 1990s with 0.3 births per 1000 to 0.7 births per 1000 in 2012 to 0.8 births /1000 in 2013 [15,16]. The increase in live births among some midlife women in the U.S. is reportedly due to planned births and increasing use of assisted reproductive technology [17].…”

“…For example, the levonorgestrel (LNG) intrauterine system (IUS) (a long-acting reversible contraceptive method), is a first-line therapy for heavy menstrual bleeding which is commonly experienced during midlife [15]. Perhaps more importantly, the LNG-IUS is not only an alternative to uterine ablation and hysterectomy, but also provides superior contraceptive effectiveness (equivalent to sterilization) [16].…”