Contraception in the perimenopause

Abstract

Pregnancy in women aged 40 and above is frequently unplanned and the legal abortion rate is high in this age group. Contraception and fertility are shrouded in popular mythology and many women do not appreciate either their risk of conception or the range of methods available to prevent conception. Either hormonal or non-hormonal methods of contraception may be appropriate.

PIP: While the average menopause age is 50 years, the ability to conceive diminishes gradually. Women may only be secure of having reached the end of their ability to conceive after 1 year following the last menstrual period. Many women over the age of 40 years, especially those in their late 40s, do not fully understand that they may remain at risk for pregnancy. Reflecting the unplanned nature of these pregnancies, an abortion rate of 45% of the conception rate proves significantly higher than for any other age group. Pregnancy risks for this age group also include spontaneous abortion rates reaching 26%, with maternal morality being 4 times greater than for women aged 30-39. A wide range of methods is available, however, to prevent pregnancy in women during the period between the birth of their last desired child and the natural end of heir reproductive lives. This paper considers the benefits, disadvantages, safety, age factors, and effectiveness of the combined oral contraceptive (COC) pill, the postcoital pill, the progestogen-only pill, injectable progestogens, intrauterine devices, barrier methods and spermicides, and sterilization. These methods are all effective, yet with varied degrees of appropriateness and applicability. Barrier methods and spermicides may not be readily accepted for 1st-time users in the above-40 age group, while sterilization may be relatively inappropriate at this late stage of reproductive life.