Contraception at pre-menopause

Premenopausal women should have an effective, safe, appropriate way to control pregnancy until menopause, if they do not want to get pregnant in middle age.

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If there are several months of menstruation, premenopausal women are still pregnant. In Scotland in 2008, the abortion rate for women over age 40 was 2.2 per 1,000 women. In England and Wales, in women between the ages of 40 and 44, the rate of unplanned pregnancies is 4 / 1,000, equivalent to the proportion of pregnant women under age 16. In a multicenter study, gestational age over age 40 was associated with: placental abruption, preterm birth, low birth weight and high perinatal mortality.




Many methods of contraception




Hormones: oral contraceptives (OCs) such as estrogen-progesterone combined contraceptives or progesterone birth control pills. Contraception of non-oral endocrine such as injection, patch or vaginal ring.




Hormone devices with or without hormones: For the first 3 to 6 months of use, bleeding may occur, cause more menstrual bleeding and abdominal pain. A 2011 study comparing the effect of a levonorgestrel-releasing intrauterine system (LNG-IUS) with the use of systemic progesterone alone in women taking estrogen replacement therapy It has been shown that LNG-IUS effectively reduces the rate of endometrial hyperplasia and relieves the symptoms of menopause more effectively.




Sterilization: tubal sterilization or ovariectomy or vasectomy in men.




Barrier method (diaphragm + spermicide, spermicide, male and female condoms): many recommend that regular and proper use of barrier methods can increase the effectiveness of contraception by 95 to 98%. .




Family planning (circadian rhythm) is not recommended for premenopausal women because irregular menstrual cycles make it difficult to predict ovulation. Emergency contraception can also be used when a method of use is found to be unsafe, however, it is not recommended for routine use. Keep in mind that only one method of contraception that prevents HIV and sexually transmitted diseases is condoms.




In the years 2008-2009, data from the National Bureau of Statistics surveyed 40-49-year-old women using at least one method of contraception. The results of the four most commonly used methods were: sterilization , oral contraceptives, male condoms and intrauterine devices. Many recommend that hormonal contraceptives be used, including oral contraceptives combined with contraceptive patches and combined hormonal contraception (CHC).




Contraceptives in premenopausal women - Figure 1

Caution when using hormonal contraceptives




Hormonal contraceptives may have some benefits beyond contraceptive use and are usually administered orally.




In addition to some network benefits, hormonal contraceptives in premenopausal women are associated with increased risk of blood clots and the risk of heart attack, stroke, and breast cancer. In 2002, a large study published in the United States on the risk of breast cancer occurred when oral contraceptives combined with oral contraceptives in perimenopausal women showed no association between drug use and Cancer risk until age 64. However, many smaller studies show that there is a connection, so the issue is still controversial.




Premenopausal women should not use estrogen-containing contraceptives if they are smoking or have a history of estrogen dependent disease, heart disease, hypertension, diabetes or blood clots. Ectopic pregnancy is safe for women over 35 without smoking.




Hormonal contraceptives can mask signs of menopause such as irregular menstruation, so it is difficult to know when menopause occurs.


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Using any combination of estrogen-progesterone-containing birth control pills results in bleeding menstrual bleeding, even after menopause.










Some researchers have suggested stopping the use of hormonal contraceptives in women 51 years of age (average menopause) or some other clinician recommends at age 55. However, this strategy is not It is always appropriate, as not all women are at menopause at the same time and still need to control pregnancy.




Benefits beyond contraceptive use of hormonal contraceptives




- Periodontal regulation.




- decreased blood volume (reduces the rate of iron deficiency anemia).




- Reduce abdominal pain during menstruation.

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Reducing the risk of ovarian cancer and cervical cancer: In many studies, the risk of dying from ovarian cancer or endometrial cancer has decreased markedly in many studies, The study also concluded that the use of postmenopausal hormonal contraceptives would reduce the incidence of ovarian cysts and ovarian tumors and provide protection for 15 years or more after discontinuation.




- Reduced hot flashes: many small studies have shown