Contraception and hormonal management in the perimenopause

Margaret E. Long, Stephanie S. Faubion, Kathy Mac Laughlin, Sandhya Pruthi, Petra Marcela Casey

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

This literature review focuses on contraception in perimenopausal women. As women age, their fecundity decreases but does not disappear until menopause. After age 40, 75% of pregnancies are unplanned and may result in profound physical and emotional impact. Clinical evaluation must be relied on to diagnose menopause, since hormonal levels fluctuate widely. Until menopause is confirmed, some potential for pregnancy remains; at age 45, women's sterility rate is 55%. Older gravidas experience higher rates of diabetes, hypertension, and death. Many safe and effective contraceptive options are available to perimenopausal women. In addition to preventing an unplanned and higher-risk pregnancy, perimenopausal contraception may improve abnormal uterine bleeding, hot flashes, and menstrual migraines. Long-acting reversible contraceptives, including the levonorgestrel intrauterine system (LNG-IUS), the etonogestrel subdermal implant (ESI), and the copper intrauterine device (Cu-IUD), provide high efficacy without estrogen. LNG-IUS markedly decreases menorrhagia commonly seen in perimenopause. Both ESI and LNG-IUS provide endometrial protection for women using estrogen for vasomotor symptoms. Women without cardiovascular risk factors can safely use combined hormonal contraception. The CDC's Medical Eligibility Criteria for Contraceptive Use informs choices for women with comorbidities. No medical contraindications exist for levonorgestrel emergency-contraceptive pills, though obesity does decrease efficacy. In contrast, the Cu-IUD provides reliable emergency and ongoing contraception regardless of body mass index (BMI).

Original languageEnglish (US)
Pages (from-to)3-10
Number of pages8
JournalJournal of Women's Health
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2015

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Perimenopause
Contraception
Levonorgestrel
Menopause
Contraceptive Agents
Estrogens
Copper Intrauterine Devices
Postcoital Contraceptives
Unplanned Pregnancy
Hot Flashes
Postcoital Contraception
Menorrhagia
High-Risk Pregnancy
Uterine Hemorrhage
Centers for Disease Control and Prevention (U.S.)
Migraine Disorders
Infertility
Fertility
Comorbidity
Body Mass Index

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Contraception and hormonal management in the perimenopause. / Long, Margaret E.; Faubion, Stephanie S.; Mac Laughlin, Kathy; Pruthi, Sandhya; Casey, Petra Marcela.

In: Journal of Women's Health, Vol. 24, No. 1, 01.01.2015, p. 3-10.

Research output: Contribution to journalArticle

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