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Contraception in the perimenopause

Author(s): Filipa Passos

Journal: Acta Obstetrica e Ginecologia Portuguesa
ISSN 1646-5830

The perimenopause is a period in which there is a transition from normal ovulatory cycles to frequent anovulation and ultimately to permanent loss of ovarian function. Although fertility declines with advancing age, a small risk of pregnancy persists in women approaching the menopause and effective contraception needs to be considered. Specific issues need to be taken into consideration during this period, such as menstrual cycle abnormalities and vasomotor instability. Several contraceptive options may be offered to perimenopausal women, including oral contraceptives, intrauterine devices, barrier methods and tubal ligation. The overall risk associated with hormonal contraceptives is now substancially reduced, when compared with the older formulations, even in women with medical conditions. Low-estrogen-dose combined oral contraceptives may be prescribed to healthy non-smoking women up to 50 years of age. Recently, new contraceptive methods have been developed, with high efficacy rates and minor side-effects. Among these are monthly injectable systems, contraceptive vaginal rings and transdermal contraceptive systems. In spite of their promising results, these methods need to be further evaluated in perimenopausal women and more definitive data are required to confirm their advantages in this specific age group. Women should be provided with individual advice, so that they can make an informed choice after balancing benefits and risks.

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