Overview of perimenopausal contraception

Abstract

The perimenopause is accompanied by important biological and psychosocial changes. The choice of contraceptive methods for women in the perimenopause, none of which is limited by age alone, will depend on the efficacy, safety, tolerability, and potential benefit of each method in relation to the biopsychosocial profile of the individual woman. Copper intrauterine devices are highly effective in the typical user and are a very safe method with, in general, good tolerability but are of limited use in women with heavy menstrual bleeding and subserous myomata. An additional benefit of copper intrauterine devices is protection against endometrial cancer. All progestogen-based methods share a favorable cardiovascular profile, making their use safe in most perimenopausal women. Long-acting implants and intrauterine systems are user independent and highly effective. Injectables and pills depend on user compliance. There is no evidence of a significant impact on breast cancer. Their impact on the endometrium can be either a negative side-effect (irregularity) or a benefit regarding reduction of heavy menstrual bleeding. Combined hormonal contraceptives have the highest cardiovascular risk. They can act as a promoting factor for breast cancer and cervical cancer, but they have the strongest potential regarding benefits (protection against endometrial and ovarian cancer, positive effect on bone mineral density, menstrual complaints, hyperandrogenic symptoms, hot flushes, and reduced risk regarding benign ovarian cysts and benign breast tumors).

Chinese abstract

伴随围绝经期出现的是一些重要的生物学和社会心理学变化。围绝经期避孕方式的选择不受年龄大小的限制, 关键是要看不同个体采取不同避孕方式的有效性、安全性、耐受性和潜在的益处。铜质宫内节育器是一种常见的安全有效、使用率高的避孕方法, 其耐受性好, 但是不适合月经量多的和粘膜下肌瘤的女性。这种工具的额外益处是可以降低子宫内膜癌发病风险。所有含孕激素的避孕方法都会使心血管受益, 这对围绝经期的女性很安全。长效植入剂和宫内缓释系统可以单独使用, 效果良好。注射剂和口服药需要患者的依从性好, 没有证据表明其对乳腺癌有明显的影响, 其对内膜的影响包括不良反应（不规则出血）和有益影响（减少月经量）。复方口服避孕药心血管疾病发生风险高于其他避孕方式, 也增高乳腺癌、宫颈癌发病率, 但是它能够降低子宫内膜癌、卵巢癌风险, 对维持骨密度、调整月经、治疗高雄激素血症、缓解潮热有益, 还能降低卵巢良性囊肿和乳腺良性肿瘤的风险。

Keywords:

• Perimenopause
• specific risks
• specific benefits
• hormonal contraception
• non hormonal contraception
• counselling

Conflict of interest

No potential conflict of interest was reported by the author.

Additional information

Funding

Nil.