Contraception during the transition to menopause: a commentary

The transition to menopause presents unique clinical challenges, requiring a balance between pregnancy prevention and the management of perimenopausal symptoms and age-related comorbidities. Although fertility declines with advancing age, unintended pregnancy after age 40 remains possible and is associated with increased maternal and neonatal risks. Women who wish to avoid pregnancy need effective contraception until menopause is established.

To provide practical guidance on contraceptive counselling during the transition to menopause, considering the safety, effectiveness, noncontraceptive benefits, and limitations of available contraceptive methods.

Age alone is not a contraindication to any contraceptive method; however, the higher prevalence of cardiovascular, metabolic, and malignant conditions in this population requires individualised contraceptive counselling based on each woman's medical history, preferences, reproductive goals, and shared decision-making. Contraceptive care in midlife is more complex than pregnancy prevention alone. Contraceptive counselling should consider both the likelihood of user adherence and the noncontraceptive benefits of each method.

This commentary provides practical guidance on contraceptive counselling during the transition to menopause, reviewing the safety, effectiveness, noncontraceptive benefits, and limitations of both short-acting reversible contraceptives (SARCs) and long-acting reversible contraceptives (LARCs) to support informed, individualised contraceptive care.