[Contraception during perimenopause: The spermicides option]

In perimenopause, the increased cardiovascular and cancer risk and the increased incidence of gynaecologic disorders have a major impact on the choice of an appropriate contraceptive method. The aim of this review is to assess the potential benefit of spermicides at this stage of woman's life.

This review presents the eligibility criteria of the different contraceptive methods according to national and international guidelines, together with a literature review of the efficacy and side-effects of the two major spermicidal preparations, benzalkonium chloride and nonoxynol-9, with specific focus on the over-40 age group.

The guidelines do not contraindicate any contraceptive method in women after 40. The efficacy data of spermicides show high variation between publications, with no age-specific differences. A special group suitable for spermicide use for contraception is perimenopausal women, particularly those with contraindications to other contraceptive methods or unwilling to use them. An additional benefit of some spermicides could be their lubricant effect.

The spermicide option should be included into contraceptive counselling for women aged over 40, with evidence-based information about their mechanism of action, efficacy and safety. There is, however, a need for efficacy and acceptability studies on spermicides, with special reference to this age group.