Perimenopause and Contraception

Perimenopause And Contraception

Perimenopausal contraceptive needs are different. Women in this transitional phase face unique physiological, hormonal, and clinical considerations that affect both fertility and health risks.

Why is contraception needed in perimenopause

1. Declining but Unpredictable Fertility

Ovulation becomes erratic but does not stop entirely.

Although fertility declines after 35–40 years, spontaneous ovulation and pregnancy are still possible, especially in early perimenopause. This necessitates effective contraception until menopause is confirmed.

1. Increased Risk of Pregnancy Complications

Perimenopausal pregnancies carry higher risks- Miscarriage, chromosomal abnormalities, gestational diabetes, hypertension, cesarean delivery. Therefore, pregnancy prevention is more critical from a medical standpoint.

1. Age-Related Comorbidities

Women in this age group are more likely to have-hypertension, obesity, diabetes, migraine with aura. These factors can limit safe use of estrogen-containing contraceptives, requiring individualized selection (e.g., progestin-only or non-hormonal methods).

1. Need for Menstrual and Perimenopausal Symptom Control

Women in perimenopausal period often experience irregular cycles, heavy bleeding, vasomotor symptoms (hot flashes, night sweats), and premenstrual syndrome. Some contraceptives (e.g., CHCs, LNG-IUS) offer dual benefits of cycle control, symptom relief and bone health maintenance.

1. Consideration of Transition to Menopause

Contraceptive choice must account for the transition into menopause and allow smooth withdrawal or transition to hormone replacement therapy (HRT) if needed.