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Contraceptive methods and issues around the menopause: an evidence update

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Bakour SH, Hatti A, Whalen S. Contraceptive methods and issues around the menopause: an evidence updateThe Obstetrician & Gynaecologist 201719:289–97. DOI: 10.1111/tog.12416

Key content:

  • There have been a number of recent advances and an increase in the number of contraceptive methods available to perimenopausal women.
  • Other relevant issues, including transition to and diagnosis of menopause, the use of hormone replacement therapy with contraception, and when to stop contraception, are discussed.
  • Some hormonal contraceptives have added benefits in the management of common perimenopausal gynaecological problems.
  • Research and development into intrauterine contraception, microchip drug release technology, progesterone receptor modulators, male contraception and vaccines is currently underway.

Learning objectives:

  • Understand that, although women’s natural fertility declines after their mid‐30s, effective contraception is required until menopause to prevent unintended pregnancies.
  • Be aware that the risks of fetal chromosomal abnormalities, miscarriage, pregnancy complications and maternal morbidity and mortality increase for women aged 40 years and over.
  • No contraceptive method is contraindicated on the basis of age alone.
  • Clinicians must carefully consider comorbidities when prescribing women the most suitable contraception.

Ethical issues:

  • Return of fertility can be delayed for up to 1 year after discontinuing progestogen‐only injectable contraceptives; therefore, these contraceptives are not suitable for perimenopausal women considering future pregnancies.
  • Contraceptive methods with a recognised post‐fertilisation, pre‐implantation effect may not be acceptable to some women.
  • Women should be given information about all suitable contraceptive methods to make an informed choice.

Disponível em: <https://doi.org/10.1111/tog.12416>