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.