Hormonal Contraception in Perimenopause: What to Consider to Guide the Choice

Tiziana Fidecicchi; Marta Caretto; Giulia Chen; Davide Simi; Maria M. Montt Guevara; Andrea Giannini; Stefano Luisi; Tommaso Simoncini

doi:10.1055/s-0045-1811951

Seminars in Reproductive Medicine, Table of Contents

Semin Reprod Med
DOI: 10.1055/s-0045-1811951

Review Article

Hormonal Contraception in Perimenopause: What to Consider to Guide the Choice

Authors

Tiziana Fidecicchi

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

²Health Science Interdisciplinary Center, Sant'Anna School of Advanced Studies, Pisa, Italy
Marta Caretto

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Giulia Chen

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Davide Simi

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Maria M. Montt Guevara

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Andrea Giannini

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Stefano Luisi

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Tommaso Simoncini

¹Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy

Abstract

Perimenopausal women have specific needs when it comes to contraception. Although fertility rates generally decrease after age 40, pregnancy is still possible and may be associated with a higher risk of obstetric and fetal complications. Moreover, women may experience bothersome symptoms during perimenopause due to anovulatory cycles and fluctuating estrogen levels, such as abnormal uterine bleeding, vasomotor symptoms, migraines, and mood disorders. Additionally, age increases the risk of the most common side effects of well-known contraceptives, particularly those containing estrogen. For this reason, contraception counseling during perimenopause should be tailored to the woman's characteristics. It should include three steps: evaluating the woman's needs and symptoms; evaluating the potential benefits of the chosen method; evaluating risk factors that may contraindicate certain choices. No contraceptive method is contraindicated solely based on age. Among combined hormonal contraceptives, if no contraindication exists, natural estrogens should be preferred after 40 years old. On the other hand, progestin-only methods can also be safely used in the presence of cardiovascular risk factors. This review will address the main reasons why a woman may need an HC method and how to make a tailored and informed choice.

Keywords

menopause transition - vasomotor symptoms - hormonal contraception - combined oral contraceptives - long-acting reversible contraceptives

Full Text

References

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