Kontrazeption in der Perimenopause

Abstract

During perimenopause, the time immediately prior to and the first year after the last menstrual period, female reproductive capacity is low, but pregnancy is still possible. Ovulation may occur without warning and effective contraception is still necessary if pregnancy is not desired. There is no contraceptive method that is contraindicated due to age. Various contraceptive options may be offered to perimenopausal women, including oral contraceptives with low dosages of ethinylestradiol, vaginal ring, progestin pills, injectables, implants, intrauterine system with levonorgestrel, natural estrogen (estradiol) in combination with a progestin, intrauterine devices, barrier methods and tubal ligations. However, women need to receive accurate individual advice about the risks and benefits of each contraceptive method. Oral hormonal contraceptives are a safe option for healthy, normotonic non-smokers without any contraindications up until one or two years beyond menopause. In addition to the effective contraception, non-contraceptive benefits such as the treatment of bleeding disorders or dysmenorrhea play an important role. For women with contraindications against estrogens progestin-only methods (pills, injectables, implants) offer possible choices. The intrauterine system (IUS) with levonorgestrel remains the most effective contraceptive method, even in women with bleeding disorders. For smokers all estrogen-progestin combinations are contraindicated because of the known increased risk for cardiovascular disease.