Contraception for the perimenopausal woman

Introduction The North American Menopause Society (NAMS) defines perimenopause as the time from the onset of menstrual changes and menopause-related symptoms until 1 year after cessation of menses [1]. This time is typically characterized by an increasing frequency of menstrual irregularity along with menopausal-related symptoms such as hot flashes, night sweats, sleep disruption, mood fluctuations and reduced libido. There is no set time for the onset or conclusion of the perimenopause, although it usually begins when a woman is in her 40s. As the time for this transition differs from woman to woman, so does its clinical presentation. What is common among all women during the perimenopause is a gradual reduction in, but not a complete loss of, the ability to conceive. Of interest is that the unintended pregnancy rate hovers around 40% in the USA for women over the age of 40 [2]. This is an unfortunate result of a convergence of erroneous beliefs. These include: Pregnancy is nearly biologically impossible in sexually active women during the perimenopause. The canard that women engage in little to no sexual activity during their 40s or 50s that would place them at risk of becoming pregnant. Highly effective contraceptive methods are not needed and should not be used by perimenopausal women because of this as well as safety concerns. What is accurate is that, by definition, perimenopausal women who are sexually active are exposed to the risk of becoming pregnant and there are no hormonal methods of contraception, regardless of their composition or mode of delivery, that are contraindicated solely on the basis of a woman's age. In addition, such methods of contraception provide not only effective pregnancy prevention, but can also provide important non-contraceptive benefits for women during the perimenopause. To this end, we will present an overview of contraceptive methods amenable for use by women during the perimenopause and into the early years of menopause.