Contraception and hormonal management in the perimenopause

Area of Science:

• Reproductive Endocrinology
• Gynecology
• Family Planning

Background:

• Fecundity persists in perimenopausal women, leading to a high rate of unplanned pregnancies after age 40.
• Unplanned pregnancies in older women carry increased health risks, including diabetes, hypertension, and mortality.
• Diagnosing menopause requires clinical evaluation due to hormonal fluctuations, meaning pregnancy potential remains until confirmed menopause.

Purpose of the Study:

• To review safe and effective contraception options for perimenopausal women.
• To highlight the dual benefits of contraception in this demographic: preventing high-risk pregnancies and alleviating perimenopausal symptoms.
• To discuss contraceptive choices considering comorbidities and specific patient needs.

Main Methods:

• Literature review of contraception in perimenopausal women.
• Analysis of contraceptive efficacy and safety, including long-acting reversible contraceptives (LARCs) and hormonal methods.
• Consideration of the CDC's Medical Eligibility Criteria for Contraceptive Use.

Main Results:

• Many safe and effective contraceptive options are available, including levonorgestrel intrauterine systems (LNG-IUS), etonogestrel subdermal implants (ESI), and copper intrauterine devices (Cu-IUD).
• LNG-IUS and ESI offer high efficacy without estrogen and provide endometrial protection when used with estrogen for vasomotor symptoms.
• Combined hormonal contraception is safe for women without cardiovascular risk factors, while Cu-IUD is effective regardless of BMI.

Conclusions:

• Perimenopausal contraception is crucial for preventing unplanned, high-risk pregnancies.
• Contraception can also improve abnormal uterine bleeding, hot flashes, and menstrual migraines in perimenopausal women.
• Contraceptive choices should be individualized based on medical eligibility criteria and patient factors, with LARCs being a primary consideration.