Contraception in Perimenopause

contraception in perimenopause

Menopause is a significant stage in a woman’s life, marked by the cessation of her menstrual cycle and a decline in reproductive hormones. Many women seek relief from menopausal symptoms through Menopause Hormone Therapy (MHT), which can help alleviate hot flashes, mood swings, and other discomforts. However, one question that often arises among women undergoing MHT during this transition is whether they can still get pregnant. In this blog, we will explore contraception in perimenopause, the possibility of pregnancy during MHT, the factors contributing to unplanned pregnancies, the concept of ovulatory and anovulatory periods, and available contraception options for women in this stage of life.

Pregnancy during Menopause Hormone Therapy (MHT)

MHT involves the use of hormones, typically oestrogen and progesterone, to replace the declining hormone levels during menopause. While MHT is highly effective in managing menopausal symptoms, it doesn’t provide contraception. As a result, it is possible for women to become pregnant while on MHT, especially if they are not aware of their ovulatory status.

The Ovulatory and Anovulatory Phase

To understand the risk of pregnancy during MHT, it’s essential to comprehend the concept of ovulatory and anovulatory periods. Ovulation is the release of a mature egg from the ovaries, which can be fertilized by sperm, leading to pregnancy. Anovulation, on the other hand, occurs when ovulation does not take place, making pregnancy impossible during that cycle.
During perimenopause and menopause, hormonal fluctuations can lead to irregular menstrual cycles. Some women mistakenly believe they are no longer fertile because their periods become irregular. However, it’s crucial to recognize that ovulatory cycles can still occur unpredictably during menopause, even when periods are sporadic. This means that women on MHT should consider contraception until they are absolutely sure that they have reached menopause, which is typically confirmed after 12 consecutive months without a period.

Factors Contributing to Unplanned Pregnancies

Several factors contribute to unplanned pregnancies in menopausal women who are taking MHT:

  1. Irregular menstrual cycles: As mentioned earlier, the irregularity of menstrual cycles during perimenopause and early menopause can lead to confusion about fertility status.
  2. Incorrect assumptions: Some women erroneously assume that they cannot become pregnant due to their age or the fact that they are experiencing menopausal symptoms.
  3. Inconsistent MHT use: Failure to consistently take MHT medications as prescribed can result in hormonal fluctuations that increase the risk of ovulation.
  4. Medication interactions: Certain medications, such as antibiotics, can interfere with the effectiveness of hormonal contraception, potentially leading to unplanned pregnancies.

 

Contraception in Perimenopause: Options for Women on MHT

Given the possibility of pregnancy during MHT, women should consider effective contraception methods if they wish to prevent pregnancy. Here are some contraception options suitable for women in menopause or perimenopause:

  1. Barrier methods: Condoms, diaphragms, and cervical caps can be used to prevent pregnancy. These methods do not rely on hormonal regulation and can be used in combination with MHT.
  2. Intrauterine devices (IUDs): Non-hormonal IUDs contain copper and Hormonal IUDs are often referred to as Intrauterine systems (IUS’s) and contains a progestogen called Levonorgestrel and is highly effective at managing bleeding problems in the perimenopause. The Mirena Coil (IUS) contains a higher dose of Levonorgestrel which provides contraception, endometrial protection as part of MHT and helps control bleeding. There are other IUS’s available, but they are not licensed as part of MHT, although they are a good method of contraception and can often help with heavy bleeding.
  3. Hormonal contraception: Some women may opt for hormonal contraceptives like birth control pills, patches, or hormonal IUDs in addition to MHT. However, it’s essential to discuss this with a healthcare provider, as they can provide guidance on the safest and most appropriate options.
  4. Sterilization: Tubal ligation or permanent contraception may be considered by women who are certain they do not want to have any more children.

While Menopause Hormone Therapy (MHT) is a valuable option for managing menopausal symptoms, it does not provide contraception. Therefore, it’s crucial for women in perimenopause or early menopause to be aware of the possibility of pregnancy and take appropriate measures to prevent it if desired. Understanding ovulatory and anovulatory periods, along with discussing contraception options with a healthcare provider, can help women make informed choices about their reproductive health during this transformative stage of life.

 

References:
https://www.menopausematters.co.uk/contra1.php
https://www.womens-health-concern.org/help-and-advice/factsheets/contraception/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9296102/
https://www.fsrh.org/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/