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Menopause01:28

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Menopause, a natural biological process marking the end of a woman's fertility, typically occurs between the fifth and sixth decade of life. This phase is characterized by the exhaustion of the ovarian follicle pool, leading to less responsive ovaries despite the high levels of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH). The consequential decrease in estrogen production results in symptoms like hot flashes, heavy sweating, headaches, hair loss, muscle pains, vaginal...
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Vasectomy is a surgical form of male sterilization that involves severing and sealing the vasa deferentia, preventing sperm from mixing with semen during ejaculation. Because a vasectomy does not impact the testes' ability to produce testosterone, hormone levels, libido, and sexual function generally remain unchanged. While vasectomy is highly effective in preventing pregnancy, with a success rate near 99.85%, rare cases of recanalization (spontaneous reconnection) can occur. Although...
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Hormonal Regulation of the Menstrual Cycle01:22

Hormonal Regulation of the Menstrual Cycle

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The ovarian cycle regulates endometrial changes throughout a single menstrual cycle via the coordinated action of gonadotrophin-releasing hormone (GnRH) and gonadotrophins.
At puberty, GnRH begins a pulsatile release pattern, which triggers the anterior pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The frequency and amplitude of GnRH pulses vary across the menstrual cycle, with faster pulses favoring LH release and slower pulses favoring FSH...
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Hormonal Control of the Ovarian Cycle01:30

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The ovarian cycle is meticulously regulated by the hypothalamic-pituitary-gonadal axis. This cycle orchestrates the release of a mature oocyte, essential for reproduction.
Before puberty, the hypothalamus releases GnRH in a low frequency, low amplitude pulsatile manner. This along with the immature hypothalamic-pituitary-gonadal axis activity, results in low estrogen levels and the absence of a fully functional ovarian cycle.  At puberty, GnRH secretion increases in both frequency and...
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The menstrual cycle includes a critical component known as the ovarian cycle, which undergoes two main phases each month—the follicular phase and the luteal phase. The follicular phase is variable and averaging around 14 days. Ovulation, triggered by a surge in luteinizing hormone (LH), marks the transition between the two phases. The second phase, the luteal phase, is relatively consistent, lasting approximately 14 days, and is marked by the activity of the corpus luteum. While a cycle...
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The Menstrual Cycle01:19

The Menstrual Cycle

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The menstrual cycle is a recurrent sequence of changes in the uterine endometrium, specifically its functional layer, the stratum functionalis. This cycle prepares the uterus for potential pregnancy. This cycle typically spans 21–35 days, averaging 28 days, and aligns with the ovarian cycle, regulated by fluctuating levels of ovarian hormones, primarily estrogen and progesterone.
The menstrual phase occurs from days 1 to 5 and involves the shedding of the stratum functionalis, as a...
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Contraception During Perimenopause: Practical Guidance.

Giovanni Grandi1, Pierluigi Di Vinci2, Alice Sgandurra1

  • 1Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico, Modena, 41124, Italy.

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|July 22, 2022
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Summary

Contraception is safe during the climacteric period. Modern hormonal contraceptives can manage perimenopausal symptoms, prevent unintended pregnancies, and offer bone and cancer risk benefits.

Keywords:
LARCsSARCscombined oral contraceptivescontraceptionfortiesimplantsintrauterine devicesmetabolismoral contraceptivespatchperimenopausevaginal rings

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Area of Science:

  • Reproductive Endocrinology
  • Women's Health
  • Contraception

Background:

  • The climacteric period, or perimenopause, presents unique health considerations for women.
  • Hormonal changes during this stage can lead to various symptoms and health risks.
  • Effective management strategies are crucial for women's well-being during this transition.

Purpose of the Study:

  • To provide practical guidance on using modern contraceptives during the climacteric and perimenopausal stages.
  • To explore the benefits of hormonal contraceptives beyond pregnancy prevention in this age group.
  • To assist clinicians in managing contraception and the transition to menopause, including hormone therapy.

Main Methods:

  • This study is a narrative review of current literature.
  • It synthesizes evidence on the use of short- and long-acting reversible contraceptives.
  • It also discusses the initiation of postmenopausal hormone therapy.

Main Results:

  • The climacteric period is not a contraindication for safe contraception.
  • Modern contraceptives, particularly hormonal ones, offer benefits such as menstrual cycle control, reduced vasomotor symptoms, and protection against bone loss.
  • Contraceptives can also have a positive oncological risk/benefit balance.

Conclusions:

  • Comprehensive contraceptive counseling is essential for women of all ages, especially during the climacteric transition.
  • Hormonal contraceptives can be safely and effectively used to manage perimenopausal symptoms and prevent unintended pregnancies.
  • Clinicians should consider the multifaceted benefits of contraception and hormone therapy for women in this life stage.