Contraception meets HRT: seeking optimal management of the perimenopause.

Abstract

Perimenopausal patients present with vasomotor, psychological, and urological symptoms as well as disturbance of their bleeding pattern. Pregnancy risk is not always something they are aware of and consequently can sometimes be overlooked. Similarities and overlap exist between products used for contraception and those used as hormone replacement, but as yet no product is licensed for both. A complicating factor in these consultations is that when clinicians use the word ‘menopause’ they mean cessation of ovulation, whereas patients use the same word to describe the symptoms they are suffering (Box 1).1 Patients often recount ‘early menopause’ in family members, but are not describing early cessation of menses, indeed the actual date of final menstrual period (FMP) is often unknown, as many women have been taking cyclical hormone replacement therapy (HRT) or hormonal contraception. Clarification of these definitions at an early stage in the consultation is important, as genuine early or premature menopause is a risk factor for osteoporosis, heart disease, and dementia; these patients need to understand the benefits of HRT up until at least the age of 50 years.2 Box 1. ### Medical definitions1 #### Perimenopause/climacteric #### Menopause #### Postmenopause