Contraception in perimenopausal women

During perimenopause, i. e. immediately prior to menopause until the end of the first year after a woman’s last menstruation, fertility has not entirely ceased. Ovulation may occur spontaneously thus effective contraception is still necessary especially if a pregnancy is not desired. No contraceptive method is contraindicated only because of the advanced age.Therefore, perimenopausal women can choose between various contraceptive methods including oral contraceptives containing low-dose ethinylestradiol, transdermal patches, vaginal rings, progestins – pills, injectables, implants, the levonorgestrel intrauterine system, natural estrogen (estradiol) – progestin combinations, copper based intrauterine devices, barrier methods and tubal ligation. However, women should receive accurate individualized advice concerning the risks and benefits of each contraceptive method. Up to one or two years beyond menopause, the combined oral contraceptive pill (COCP) is a safe option for healthy non-smokers without contraindications and normal blood pressure but suffering from climacteric symptoms.The use of low dose oral contraceptives offers many benefits.Therefore, women having cardiovascular risk factors or active smokers should opt for progesteron-only products (pills, injectables, implants), the levonorgestrel intrauterine system (IUS), intrauterine devices (IUD), barrier methods or sterilization. For smokers, all combined oral contraceptive products are contraindicated because of the significant risk for cardiovascular disease.