Contraceptive needs of the perimenopausal woman

Contraception for the perimenopausal woman

Perimenopause, or the menopause transition, is a time in a woman's life that bridges her reproductive years through to the non-surgical cessation of ovulation, or menopause. For many women this time is one of changes: changes in gynecological issues, onset of symptoms not experienced in her youth and increasing risks for adverse medical conditions. Despite the clear changes that occur for many women during this time, one critical issue is frequently ignored, namely, that, until the onset of menopause, she is exposed to pregnancy if sexually active, and pregnancy for older reproductive women is fraught with considerable increases in morbidity and mortality compared to younger women. This paper will present a review of the reproductive issues of the perimenopause and interventions geared to preventing pregnancy and relieving menopause-related symptoms. As counseling remains a critical aspect in empowering women to make informed choices about their health care, this paper will present current evidence that will help clinicians provide accurate reproductive counseling to women in the menopause transition.

Perimenopausal contraception in Turkish women: A cross-sectional study

BACKGROUND

Epidemiologic research has shown that perimenopausal contraception is an important medical issue, because women during the perimenopause still need effective contraception. The objective of the study was to assess the contraceptive choices of perimenopausal Turkish women.

METHODS

This is a descriptive cross-sectional study that in a non - random fashion recruited 202 perimenopausal and naturally menopausal women who lived in a suburban area of Istanbul. Women who took part were aged between 45-59 years old. Chief database used to identify the suitable participants in the district. Subjects who voluntarily participated in the study were interviewed in their homes by the researcher. The analysis of the data was evaluated using percentages.

RESULTS

The percentage of sexually active women among the participants was 87.6%. A large majority - 80.2% - of the participants did not have any idea of when they should bring contraception to an end. The method most commonly used was withdrawal (Coitus Interruptus), represented by 38.8%. In regard to the participants' choices of medical contraception, those being utilized were the IUD (24.3%), tubal sterilization (8.9%), condom (5.9%) and COC (6.4%). Additionally, 18% of women used other traditional methods including vaginal lavage, vaginal aspirin, and even inserting a small sponge presoaked with fresh lemon juice or cola deep into the vagina. Among the perimenopausal women who participated, the IUD was the most popular and appropriate contraceptive method.

CONCLUSION

Most perimenopausal Turkish women are still using traditional methods and women's knowledge about contraception in the menopausal stages is very limited. Health professionals should provide information about perimenopausal contraception.

Different routes of progesterone administration and polycystic ovary syndrome: a review of the literature

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in woman of reproductive age. Although extensive studies have been performed in past decades to investigate the pathobiological mechanisms underlying the unset of this disease, its etiology remains unknown. Progesterone is a hormone of paramount importance in ovulation, implantation and luteal phase support. Low levels of progesterone have been found in the early luteal phase in PCOS patients. Granulosa cells from polycystic ovaries show an altered progesterone production. Moreover, the lack of cyclical exposure to progesterone may have a role in the development of the gonadotropin and androgen abnormalities found in PCOS patients. Ovulation failure and progesterone deficiency may facilitate the hypothalamic-pituitary abnormalities causing the associated disordered luteinizing hormone secretion in PCOS. Progesterone may be administered to PCOS patients in the following cases: to induce withdrawal bleeding, to suppress secretion of luteinizing hormone, in ovulation induction in clomiphene citrate-resistant patients and in luteal phase support in assisted reproduction. We discuss the pharmacologic characteristics of the different routes of progesterone administration with reference to these diverse indications, the therapeutic objectives and patient compliance.