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Review
. 2022 Jul 15:14:913-929.
doi: 10.2147/IJWH.S288070. eCollection 2022.

Contraception During Perimenopause: Practical Guidance

Giovanni Grandi  1 , Pierluigi Di Vinci  2 , Alice Sgandurra  1 , Lia Feliciello  1 , Francesca Monari  1 , Fabio Facchinetti  1
Affiliations
Review

Contraception During Perimenopause: Practical Guidance

Giovanni Grandi et al. Int J Womens Health. .

Abstract

Climacteric is by no means in itself a contraindication to safe contraception. On the contrary, there are several conditions related to the perimenopause that could benefit from the use of modern contraceptives, mainly hormonal, with the goals of avoiding unintended pregnancies and giving further possible benefits beyond contraception (menstrual cycle control, a reduction of vasomotor symptoms and menstrual migraines, a protection against bone loss, a positive oncological risk/benefit balance). This narrative review aims to provide practical guidance on their possible use in this particular life stage, both short- and long-acting reversible contraceptives, and to assist clinicians for women transitioning from contraception to their menopausal years, including the possible initiation of postmenopausal hormone therapy. Comprehensive contraceptive counselling is an essential aspect of the overall health and wellbeing of women and should be addressed with each such patient irrespective of age.

Keywords: LARCs; SARCs; combined oral contraceptives; contraception; forties; implants; intrauterine devices; metabolism; oral contraceptives; patch; perimenopause; vaginal rings.

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Conflict of interest statement

Giovanni Grandi received honoraria for sponsored lectures and participation in advisory boards from Bayer AG, Italfarmaco, Theramex, Organon, Gedeon Richter and Exeltis, not related to this manuscript. Fabio Facchinetti reports personal fees from JnJ outside the submitted work. The authors report no other potential conflicts of interest in relation to this work.

Figures

Figure 1
Figure 1
Comparisons between the percentage of voluntary abortions between 2010 and 2020 according to the different age groups in the Emilia-Romagna region (Italy).
Figure 2
Figure 2
Pros and cons of the use of combined hormonal contraceptives (CHCs) or progestin-only contraceptives in the perimenopause.
Figure 3
Figure 3
When to stop contraception? In the case of progestin-only pill, implant and levonorgestrel-realising intrauterine system use (A), depot medroxyprogesterone acetate use (B) and combined hormonal contraceptive (pill, vaginal ring and patch) use (C).
See this image and copyright information in PMC

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