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  • Title: Contraception during perimenopausal years is important issue for patients, clinicians.
    Author: Colls JP.
    Journal: Contracept Technol Update; 1984 Dec; 5(12):158-60. PubMed ID: 12339714.
    Abstract:
    Family planning practitioners who work with women in the perimenopausal years should educate patients about the need for contraception until 1 year past the last menstrual period, rule out contraindications to specific fertility control methods, and provide women with the opportunity to choose the method best suited for them. Women in the perimenopausal years are at increased risk of aging-related problems such as cardiovascular disease and diabetes, genetic defects in offspring, morbidity with a pregnancy, and mortality from a pregnancy. In working with these women, clinicians should evaluate the absolute and strong relative contraindications of hormonal contraception, IUDs, barriers and spermicides, natural family planning (NFP), and sterilization. Any method of combination hormonal contraception is conttraindicated for smokers aged 35 years and over. Although progestin-only pills are safer for women at risk of hypertension, possible irregular bleeding during the menstrual cycle caused by these preparations can disquise progressively involutional periods or lead women to ignore cancer warning signs. Although the IUD can be considered for perimenopausal women, it should be reconsidered if intermenstrual bleeding occurs. Barrier methods are popular among women with decreased fertility potential who are largely monogamous. Uterine and urethral changes in older women may discourage diaphragm use. However, the spermicides in contraceptive jellies and sponges can provide lubrication for women with symptoms of dry vagina. Vaginal spermicides are used heavily by women in the final 1/3 of their childbearing years. Women nearing menopause should not use NFP methods because of the irregularity of mucus and temperture patterns. Finally, the 1-time risk of tubal sterilization poses less threat to healthy women ages 35-40 years than oral contraception or a term pregnancy.
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