During the transition years leading to menopause, the possibility of conception persists, although at a lower rate. Contraceptive choices available to perimenopausal women are as varied as those for their younger counterparts, albeit with some limitations related predominantly to coexisting medical conditions rather than the advancing age itself. In this review, different contraceptive choices pertaining to this age group will be discussed, with a focus on evidence-based data.
Papers of special note have been highlighted as either of interest (•) or of considerable interest (••) to readers.
2.
GoldEBBrombergerJCrawfordS: Factors associated with age at natural menopause in a multiethnic sample of midlife women. Am. J. Epidemiol.153, 865–874 (2001).
3.
de BruinJPBovenhuisHvan NoordPA: The role of genetic factors in age at natural menopause. Hum. Reprod.16, 2014–2018 (2001).
4.
GougeonAEcochardRThalabardJ: Age-related changes of the population of human ovarian follicles: increase in the disappearance rate of non-growing and early-growing follicles in aging women. Biol. Reprod.50, 653–663 (1994).
5.
McKinlaySMBrambillaDJPosnerJG: The normal menopause transition. Maturitas14, 103–115 (1992).
6.
BastianLASmithCMNandaK: Is this woman perimenopausal?JAMA289, 895–902 (2003).
7.
SantoroNBrownJAdelTSkurnickJ: Characterization of reproductive hormonal dynamics in the perimenopause. J. Clin. Endocrinol. Metab.81, 1495–1501 (1996).
8.
KronenbergF: Hot flashes: epidemiology and physiology. Ann. N. Y. Acad. Sci.592, 52–86 (1990).
9.
StovallDTomaSHammondMTalbertL: The effect of age on female fecundity. Obstet. Gynecol.77, 33–36 (1991).
10.
SperoffL: The effect of aging on fertility. Curr. Opin. Obstet. Gynecol.6, 115–120 (1994).
11.
SauerMPaulsonRAryBLoboR: Three hundred cycles of oocyte donation at the University of Southern California: assessing the effect of age and infertility diagnosis on pregnancy and implantation rates. J. Assist. Reprod. Genet.11, 92–95 (1994).
12.
TonerJPFloodJT: Fertility after the age of 40. Obstet. Gynecol. Clin. North Am.20, 261–272 (1993).
13.
TietzeC: Reproductive span and rate of reproduction among Hutterite women. Fertil. Steril.8, 89–97 (1957).
14.
Classical paper, not replicated yet, addressing the effect of age on fertility. Data was obtained from a population of Hutterites who do not practice any form of contraception.
15.
JonesRKDarrochJEHenshawSK: Contraceptive use among US women having abortions in 2000–2001. Perspect. Sex Reprod. Health34, 294–303 (2002).
16.
Questionnaire-based study about lack of contraception and contraceptive failures among 10,683 women seeking pregnancy termination.
17.
BassonR: Recent advances in women's sexual function and dysfunction. Menopause11, 714–725 (2004).
18.
PiperJMKennedyDL: Oral contraceptives in the United States: trends in content and potency. Int. J. Epidemiol.16, 215–221 (1987).
19.
TrussellJ: Contraceptive failure in the United States. Contraception70, 89–96 (2004).
20.
Key paper addressing theoretical and use-failure rates of all contraceptives in the USA, with emphasis on shortcomings of calculation methods.
21.
GerstmanBBPiperJMTomitaDKFergusonWJStadelBVLundinFE: Oral contraceptive estrogen dose and the risk of deep venous thromboembolic disease. Am. J. Epidemiol.133, 32–37 (1991).
22.
NightingaleALLawrensonRASimpsonELWilliamsTJMacRaeKDFarmerRD: The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives. Eur. J. Contracept. Reprod. Health Care5, 265–274 (2000).
23.
Cardiovascular Disease and Steroid Hormone Contraception: report of a WHO Scientific Group. Geneva, Switzerland: WHO Scientific Group on Cardiovascular Disease and Steroid Hormone Contraception; WHO Technical Report No. 877 (1998).
24.
A much-quoted report that concluded that combined oral contraceptive (COC) use is safe in women of advanced reproductive age in the absence of smoking, diabetes and cardiovascular disease.
25.
WuORobertsonLLanghorneP: Oral contraceptives, hormone replacement therapy, thrombophilias and risk of venous thromboembolism: a systematic review. The Thrombosis: Risk and Economic Assessment of Thrombophilia Screening (TREATS) Study. Thromb. Haemost.94, 17–25 (2005).
26.
MohllajeeAPCurtisKMMartinsSLPetersonHB: Does use of hormonal contraceptives among women with thrombogenic mutations increase their risk of venous thromboembolism? A systematic review. Contraception73, 166–178 (2006).
27.
An updated reference about currently available information regarding risk of venous thromboembolism in COC users with or without different thrombogenic mutations.
28.
WinklerUH: Blood coagulation and oral contraceptives. A critical review. Contraception57(3), 203–209 (1998).
29.
World Health Organization Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception: effect of different progestagens in low oestrogen oral contraceptives on venous thromboembolic disease. Lancet346, 1582–1588 (1995).
30.
BonnarJ: Can more be done in obstetric and gynecologic practice to reduce morbidity and mortality associated with venous thromboembolism?Am. J. Obstet. Gynecol.180, 784–791 (1999).
31.
SidneySPetittiDBQuesenberryCPJrKlatskyALZielHKWolfS: Myocardial infarction in users of low-dose oral contraceptives. Obstet. Gynecol.88(6), 939–944 (1996).
32.
RosenbergLPalmerJRRaoRSShapiroS: Low-dose oral contraceptive use and the risk of myocardial infarction. Arch. Intern. Med.161, 1065–1070 (2001).
33.
ACOG Practice Bulletin: The use of hormonal contraception in women with coexisting medical conditions. Number 18 (2000).
34.
CurtisKMMohllajeeAPPetersonHB: Use of combined oral contraceptives among women with migraine and nonmigrainous headaches: a systematic review. Contraception73, 189–194 (2006).
35.
ChanWSRayJWaiEK: Risk of stroke in women exposed to low-dose oral contraceptives: a critical evaluation of the evidence. Arch. Intern. Med.164, 741–747 (2004).
36.
SchwartzSMPetittiDBSiscovickDS: Stroke and use of low-dose oral contraceptives in young women: a pooled analysis of two US studies. Stroke29, 2277–2284 (1998).
37.
SuwikromSJaisamrarnU: Comparison of the metabolic effects of oral contraceptive and nonhormonal contraceptive use in women over 40 years old. Contraception71, 183–187 (2005).
GalloMFNandaKGrimesDASchulzKF: Twenty micrograms vs. >20 microg estrogen oral contraceptives for contraception: systematic review of randomized controlled trials. Contraception71, 162–169 (2005).
40.
Review of the effect of estrogen dose in COC on different outcome measures is limited by the heterogeneity of the progestin component.
41.
BarbosaICFilhoCIFaggionDJrBaracatEC: Prospective, open-label, noncomparative study to assess cycle control, safety and acceptability of a new oral contraceptive containing gestodene 60 μg and ethinylestradiol 15 μg (Minesse). Contraception73, 30–33 (2006).
42.
GebbieAEGlasierASweetingV: Incidence of ovulation in perimenopausal women before and during hormone replacement therapyContraception52, 221–222 (1995).
43.
ShargilAA: Hormone replacement therapy in perimenopausal women with a triphasic contraceptive compound: a three-year prospective study. Int. J. Fertil.30, 18–28 (1985).
The first double-blind, randomized, controlled trial (RCT) to confirm the benefit of COC in treating dysfunctional uterine bleeding in unovulatory women.
46.
IyerVFarquharCJepsonR: Oral contraceptive pills for heavy menstrual bleeding. Cochrane Database Syst. Rev.2, CD000154 (2000).
47.
McPhersonKMetcalfeMAHerbertA: Severe complications of hysterectomy: the VALUE study. Br. J. Obstet. Gynaecol.111, 688–694 (2004).
48.
ProctorMLRobertsHFarquharCM: Combined oral contraceptive pill (OCP) as treatment for primary dysmenorrhoea. Cochrane Database Syst. Rev.3, CD002120 (2001).
49.
DavisARWesthoffCO'ConnellKGallagherN: Oral contraceptives for dysmenorrhea in adolescent girls: a randomized trial. Obstet. Gynecol.106, 97–104 (2005).
50.
YangCHLeeJNHsuSCKuoCHTsaiEM: Effect of hormone replacement therapy on uterine fibroids in postmenopausal women – a 3-year study. Maturitas43, 35–39 (2002).
51.
ChiaffarinoFParazziniFLa VecchiaCRicciECrosignaniPG: Oral contraceptive use and benign gynecologic conditions. Contraception57, 11–18 (1998).
52.
BurkmanRSchlesselmanJJZiemanM: Safety concerns and health benefits associated with oral contraception. Am. J. Obstet. Gynecol.90(4 Suppl.), S5–S22 (2004).
53.
Article focuses on evidence-based data regarding alleged benefits and risks of COC use.
54.
CosmanF: The prevention and treatment of osteoporosis: a review. MedGenMed7, 73 (2005).
55.
DeCherneyA: Bone-sparing properties of oral contraceptives. Am. J. Obstet. Gynecol.174, 15–20 (1996).
56.
KhanA: Management of low bone mineral density in premenopausal women. Obstet. Gynaecol. Can.27, 345–349 (2005).
57.
BaradDKooperbergCWactawski-WendeJLiuJHendrixSLWattsNB: Prior oral contraception and postmenopausal fracture: a Women's Health Initiative observational cohort study. Fertil. Steril.84, 374–383 (2005).
58.
MichaelssonKBaronJAFarahmandBYPerssonILjunghallS: Oral-contraceptive use and risk of hip fracture: a case–control study. Lancet353, 1481–1484 (1999).
59.
Collaborative Group on Hormonal Factors in Breast Cancer.Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. Lancet347, 1713–1727 (1996).
60.
Frequently quoted article about COC use and the risk of breast cancer.
61.
AlthuisMDBroganDRCoatesRJ: Hormonal content and potency of oral contraceptives and breast cancer risk among young women. Br. J. Cancer88, 50–57 (2003).
62.
NarodSADubeMPKlijnJ: Oral contraceptives and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. J. Natl Cancer Inst.94, 1773–1779 (2002).
63.
PurdieDMBainCJSiskindVWebbPMGreenAC: Ovulation and risk of epithelial ovarian cancer. Int. J. Cancer104, 228–232 (2003).
64.
The Cancer and Steroid Hormone Study of the Centers for Disease Control and the National Institute of Child Health and Human Development: the reduction in risk of ovarian cancer associated with oral-contraceptive use. N. Engl. J. Med.316, 650–655 (1987).
65.
NessRBGrissoJAKlapperJ: Risk of ovarian cancer in relation to estrogen and progestin dose and use characteristics of oral contraceptives. SHARE Study Group. Steroid hormones and reproductions. Am. J. Epidemiol.152, 233–241 (2000).
66.
WalkerGRSchlesselmanJJNessRB: Family history of cancer, oral contraceptive use, and ovarian cancer risk. Am. J. Obstet. Gynecol.186, 8–14 (2002).
67.
GrenaderTPeretzTLifchitzMShavitL: BRCA1 and BRCA2 germ-line mutations and oral contraceptives: to use or not to use. Breast14, 264–268 (2005).
68.
SchlesselmanJJ: Risk of endometrial cancer in relation to use of combined oral contraceptives. A practitioner's guide to meta-analysis. Hum. Reprod.12, 1851–1863 (1997).
69.
FernandezELa VecchiaCBalducciAChatenoudLFranceschiSNegriE: Oral contraceptives and colorectal cancer risk: a meta-analysis. Br. J. Cancer84, 722–727 (2001).
70.
SmithJSGreenJde GonzalezBerrington A: Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet361(9364), 1159–1167 (2003).
71.
TonkenlaarDOddensBJ: Preferred frequency and characteristics of menstrual bleeding in relation to reproductive status, oral contraceptive use and hormone replacement therapy use. Contraception59, 357–362 (1999).
72.
GoaKLWarnerGTEasthopeSE: Transdermal ethinylestradiol/norelgestromin: a review of its use in hormonal contraception. Treat. Endocrinol.2, 191–206 (2003).
73.
JickSSKayeJARussmannSJickH: Risk of nonfatal venous thromboembolism in women using a contraceptive transdermal patch and oral contraceptives containing norgestimate and 35 μg of ethinyl estradiol. Contraception73, 223–228 (2006).
74.
SarkarNN: The combined contraceptive vaginal device (NuvaRing): a comprehensive review. Eur. J. Contracept. Reprod. Health Care10, 73–78 (2005).
75.
van den HeuvelMWvan BragtAJAlnabawyAKKapteinMC: Comparison of ethinylestradiol pharmacokinetics in three hormonal contraceptive formulations: the vaginal ring, the transdermal patch and an oral contraceptive. Contraception72, 168–174 (2005).
HeinemannLAAssmannADoMinhTGarbeE: Oral progestogen-only contraceptives and cardiovascular risk: results from the Transnational Study on Oral Contraceptives and the Health of Young Women. Eur. J. Contracept. Reprod. Health Care4, 67–73 (1999).
80.
CurtisKMMartinsSL: Progestogen-only contraception and bone mineral density: a systematic review. Contraception73, 470–487 (2006).
81.
A useful review on bone mineral density and use of all progestin-only contraceptives (oral, injection, subdermal and progestin intrauterine device).
82.
KumleMWeiderpassEBraatenT: Use of oral contraceptives and breast cancer risk: The Norwegian-Swedish Women's Lifestyle and Health Cohort Study. Cancer Epidemiol. Biomarkers Prev.11, 1375–1381 (2002).
83.
BenagianoGPrimieroFM: Seventy-five microgram desogestrel minipill, a new perspective in estrogen-free contraception. Ann. N. Y. Acad. Sci.997, 163–173 (2003).
84.
BarnabeiVMGradyDStovallDW: Menopausal symptoms in older women and the effects of treatment with hormone therapy. Obstet. Gynecol.100, 1209–1218 (2002).
85.
CundyTCornishJRobertsHReidIR: Menopausal bone loss in long-term users of depot medroxyprogesterone acetate contraception. Am. J. Obstet. Gynecol.186, 978–983 (2002).
86.
BeksinskaMESmitJAKleinschmidtIFarleyTMMbathaF: Bone mineral density in women aged 40–49 years using depot-medroxyprogesterone acetate, norethisterone enanthate or combined oral contraceptives for contraception. Contraception71, 170–175 (2005).
87.
StromBLBerlinJAWeberAL: Absence of an effect of injectable and implantable progestin-only contraceptives on subsequent risk of breast cancer. Contraception.69, 353–360 (2004).
88.
JainJJakimiukAJBodeFRRossDKaunitzAM: Contraceptive efficacy and safety of DMPA-SC. Contraception70, 269–275 (2004).
89.
FunkSMillerMMMishellDRJr: The Implanon US Study Group: Safety and efficacy of Implanon, a single-rod implantable contraceptive containing etonogestrel. Contraception71, 319–326 (2005).
90.
BooranabunyatSTaneepanichskulS: Implanon use in Thai women above the age of 35 years. Contraception69, 489–491 (2004).
91.
GrimesDA: Related Intrauterine device and upper-genital-tract infection. Lancet356(9234), 1013–1019 (2000).
92.
An excellent and extensive review that put into perspective the alleged role of the intrauterine device in the development of pelvic inflammatory disease.
93.
AnderssonKOdlindVRyboG: Levonorgestrel-releasing and copper-releasing (Nova T) IUDs during five years of use: a randomized comparative trial. Contraception49, 56–72 (1994).
94.
SivinISternJDiazJ: Two years of intrauterine contraception with levonorgestrel and with copper: a randomized comparison of the TCu 380Ag and levonorgestrel 20 mcg/day devices. Contraception35, 245–255 (1987).
95.
HubacherDGrimesDA: Noncontraceptive health benefits of intrauterine devices: a systematic review. Obstet. Gynecol. Surv.57, 120–128 (2002).
96.
SuhonenSHolmstromTLahteenmakiP: Three-year follow-up of the use of a levonorgestrel-releasing intrauterine system in hormone replacement therapy. Acta Obstet. Gynecol. Scand.76, 145–150 (1997).
97.
KayikciogluFGunesMOzdegirmenciO: Effects of levonorgestrel-releasing intrauterine system on glucose and lipid metabolism: a 1-year follow-up study. Contraception73, 528–531 (2006).
98.
BahamondesLEspejo-ArceXHidalgoMM: A cross-sectional study of the forearm bone density of long-term users of levonorgestrel-releasing intrauterine system. Hum. Reprod.21, 1316–1319 (2006).
99.
BackmanTRauramoIJaakkolaK: Use of the levonorgestrel-releasing intrauterine system and breast cancer. Obstet. Gynecol.106, 813–817 (2005).
100.
SivinISternJ: Health during prolonged use of levonorgestrel 20 micrograms/d and the copper TCu 380Ag intrauterine contraceptive devices: a multicenter study. International Committee for Contraception Research (ICCR). Fertil. Steril.61, 70–77 (1994).
101.
WildemeerschDBatarIAffandiB: The ‘frameless’ intrauterine system for long-term, reversible contraception: a review of 15 years of clinical experience. J. Obstet. Gynaecol. Res.29, 164–173 (2003).
102.
GrimesDAGalloMFGrigorievaVNandaKSchulzKF: Fertility awareness-based methods for contraception: systematic review of randomized controlled trials. Contraception72, 85–90 (2005).
103.
In an area where reports are conflicting, this article reviews only RCTs to present evidence-based information.
104.
GalloMFGrimesDASchulzKF: Cervical cap versus diaphragm for contraception. Cochrane Database Syst. Rev.CD003551 (2002).
105.
MauckCGloverLHMillerE: Lea's Shield: a study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide. Contraception53, 329–335 (1996).
106.
TrussellJEllertsonCStewartF: The role of emergency contraception. Am. J. Obstet. Gynecol.190(Suppl. 4), S30–S38 (2004).
107.
ACOG Practice Bulletin: Emergency contraception. Number 69 (2005).
Review of evidence regarding female sterilization: anesthesia, methods, failure as a function of method, postoperative complications and long-term benefits.
110.
CurtisKMMohllajeeAPPetersonHB: Regret following female sterilization at a young age: a systematic review. Contraception73, 205–210 (2006).
111.
DuffySMarshFRogersonL: Female sterilisation: a cohort controlled comparative study of ESSURE versus laparoscopic sterilisation. BJOG112, 1522–1528 (2005).
112.
CreininMD: Laboratory criteria for menopause in women using oral contraceptives. Fertil. Steril.66, 101–104 (1996).
113.
CastracaneVDGimpelTGoldzieherJW: When is it safe to switch from oral contraceptives to hormonal replacement therapy?Contraception52, 371–376 (1995).
114.
BeksinskaMESmitJAKleinschmidtI: Detection of raised FSH levels among older women using depomedroxyprogesterone acetate and norethisterone enanthate. Contraception68, 339–343 (2003).
115.
ReapeKZ: Current contraceptive research and development. Adolesc. Med. Clin.16, 617–633 (2005).
116.
Useful review regarding rationale for current contraceptive research and development. Caution: some trials mentioned in the article were suspended after publication.
117.
WildemeerschDDhontMWeyersSTemmermanM: Miniature, low-dose, intrauterine drug-delivery systems. Ann. N. Y. Acad. Sci.997, 174–184 (2003).
118.
WiegratzILeeJHKutscheraEWinklerUHKuhl: Effect of four oral contraceptives on hemostatic parametersContraception70, 97–106 (2004).
119.
Sitruk-WareR: New progestagens for contraceptive use. Hum. Reprod. Update12, 169–178 (2006).
