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In their recent review, Hardman and Gebbie provide a great service to colleagues who face questions on the need for contraception in the perimenopause [1]. The manuscript is very practical, giving a little background and mainly focusing on various options for contraception, and their advantages or side-effects. The authors also present an algorithm for a multitude of perimenopausal situations. Here is the review Abstract: 


‘Perimenopausal women have low fertility but must still be advised to use contraception until natural sterility is reached if they are sexually active. Patterns of contraceptive use vary in different countries world-wide. Long-acting, reversible contraceptive methods offer reliable contraception that may be an alternative to sterilization. Hormonal methods confer significant non-contraceptive benefits, and each individual woman should weigh up the benefits and risks of a particular method. No method of contraception is contraindicated by age alone, although combined hormonal contraception and injectable progestogens are not recommended for women over the age of 50 years. The intrauterine system has particular advantages as a low-dose method of effective hormonal contraception, which also offers control of menstrual dysfunction and endometrial protection in women requiring estrogen replacement. Condoms are recommended for personal protection against sexually transmitted infections in new relationships. Standard hormone replacement therapy is not a method of contraception.’


  • Risto Erkkola
    Department of Obstetrics and Gynecology, University Central Hospital, Turku, Finland


  1. Hardman SM, Gebbie AE. The contraception needs of the perimenopausal woman. Best Practice Res Clin Obstet Gynaecol 2014;28:903-15
  2. Jones J, Mosher W, Daniels K. Division of Vital Statistics. Current contraceptive use in the United States, 20062010, and Changes in patterns of use since 1995. National Health Statistic Reports, Number 60, 2012 October 18
  3. Lidegaard Ø, Edström B, Kreiner S. Oral contraceptives and venous thromboembolism: five-year national case-control study. Contraception 2002;65:187-96
  4. Edelman AB, Gallo MF, Jensen JT, Nichols MD, Grimes DA. Continuous or extended cycle versus cyclic use of combined oral contraceptives for contraception. Cochrane Database System Rev 2005(3), Art. No: CD004695
  5. Mandel FP, Geola FL, Lu JK, et al. Biologic effects of various doses of ethinyl estradiol in postmenopausal women. Obstet Gynecol 1982;59:673-9
  6. Erkkola R, Landgren BM. Role of progestins in contraception. Acta Obstet Gynecol Scand 2005;84:207-16
  7. Erkkola R. Recent advances in hormonal contraception. Curr Opin Obstet Gynecol 2007;19:547-53

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