Contraception in adolescence and the perimenopause

Abstract

<h2>Abstract</h2> There are no contraceptive methods that are contraindicated on the basis of age alone. For a woman of any age, efficacy and compliance are optimized if she is using her own choice of method. Nevertheless, there are special issues that must be taken into account by clinicians advising adolescent or perimenopausal women about contraceptive choices. For adolescents, specific legal and ethical issues pertain. Clinicians must document that they have applied the Fraser criteria in assessing a young woman's competence to provide valid consent. Clinicians must be alert to child protection issues and familiar with local procedures, and must understand their duty of confidentiality and circumstances in which confidentiality may have to be breached. Although no contraceptive methods are contraindicated, risks and benefits must be weighed in making choices. Considerations of efficacy and compliance mean that the progestogen-only pill is generally less suitable. Concern about bone mineral density must be balanced against user-independence if considering depot medroxyprogesterone acetate. Beneficial effects on bone mineral density and acne favour combined oral contraception. In the perimenopause, special issues centre on the dilemmas of when contraception can be stopped and concurrent HRT. In general, any woman can safely stop contraception at age 55 years. An algorithm to assist decision-making about stopping contraception at younger ages is provided. A progestogen-only method can safely be used alongside HRT to provide effective contraception.