Key content
There have been a number of recent advances and an increase in the number of contraceptive methods available to perimenopausal women.
 Other relevant issues, including transition to and diagnosis of menopause, the use of hormone replacement therapy with contraception, and when to stop contraception, are discussed.
Some hormonal contraceptives have added benefits in the management of common perimenopausal
gynaecological problems.
Research and development into intrauterine contraception, microchip drug release technology, progesterone receptor modulators, male contraception and vaccines is currently underway.
Learning objectives
Understand that, although women’s natural fertility declines after their mid-30s, effective contraception is required until menopause to prevent unintended pregnancies.
 Be aware that the risks of fetal chromosomal abnormalities,miscarriage, pregnancy complications and maternal morbidity and mortality increase for women aged 40 years and over.
 No contraceptive method is contraindicated on the basis of age alone.
 Clinicians must carefully consider comorbidities when prescribing women the most suitable contraception.
Ethical issues
 Return of fertility can be delayed for up to 1 year after discontinuing progestogen-only injectable contraceptives; therefore, these contraceptives are not suitable for perimenopausal
women considering future pregnancies.
Contraceptive methods with a recognised post-fertilisation,pre-implantation effect may not be acceptable to some women.
 Women should be given information about all suitable
contraceptive methods to make an informed choice.
Keywords: combined hormonal contraception / contraception /
contraceptive device / menopause / progestogen-only contraception

Introduction

Conception and demographics in older women

Stopping contraception

Hormone replacement therapy and contraception

Choice of methods of contraception

Combined hormonal contraception

Implants

Progestogen-only pills

Injectable contraception

Intrauterine device

Barrier contraception

Natural family planning methods

Sterilisation

Emergency contraception

Future developments

Intrauterine contraception

Microchip drug-release technology

Male contraception

Progesterone receptor modulators

Vaccines

Conclusion
In the absence of accurate evidence-based advice on fertility,contraception and HRT, perimenopausal women remain at risk of an unplanned pregnancy. There is no method of contraception that is contraindicated for women under the age of 50 years on the basis of age alone. HRT does not provide

adequate contraception. After taking a comprehensive medical history, all women should be given information on all suitable methods of contraception so that they can make an informed
choice. When giving contraceptive advice to perimenopausal women with multiple comorbidities, clinicians should carefully consider the associated risks. New research and product developments will widen the contraceptive choice for women in this age group.