[Contraception during the perimenopause]

A PERIOD OF TRANSITION:The perimenopause is a key period in the life of an adult woman. It is characterised by the instability and unpredictability of ovulation and its onset, by an increase in estrogen-dependent diseases and by a reduction in the risk of pregnancy, which, when it occurs, is physically and mentally unacceptable. MANY POSSIBLE METHODS: The physician who must recommend a contraceptive method to a patient has a wide selection of methods, but is also confronted with many relative or absolute contraindications. Although estro-progestagen contraceptives at this stage in life are only contraindicated in smokers, low dose contraceptive pills would appear preferable. However, intra-uterine devices (IUD) are often chosen, of copper or containing levonorgestrel, depending on the particularities of menstruation. Vaginal contraception is more easily adopted by women during the perimenopause than in younger women, but eventual sexual problems in older partners should not be ignored. In France, because of its general anti-estrogenic properties and effects (mastodynia, premenstrual syndrome) a pure progestagen contraceptive is not officially indicated in the case of contraception alone. Conversely, the bioactive IUD is effective in women suffering from menorrhagia. FROM HORMONE CONTRACEPTIVES TO REPLACEMENT THERAPY: It is not always easy to know, in a woman using hormone contraceptives, the date of the menopause, at which time if she wants she can change to replacement therapy, but some recent modalities have permitted the relativized this aspect of the question.