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Contraception for midlife women

a review

Miller, Taniqua A. MD1; Allen, Rebecca H. MD, MPH2; Kaunitz, Andrew M. MD3; Cwiak, Carrie A. MD, MPH1

doi: 10.1097/GME.0000000000001073
Clinical Corner: Invited Review

Family planning represents a key component of reproductive health care. Accordingly, the provision of contraception must span the reproductive age spectrum, including perimenopause. The risk of pregnancy is decreased, but not trivial, among women over 40 years of age. Evidence-based guidelines for contraceptive use can assist clinicians in counseling their patients in this population. Intrauterine contraception is one of the most effective methods and is safe to use in midlife women with few exceptions. Progestin-only contraception is another safe option for most midlife women because it is not associated with an increased risk of cardiovascular complications. Combined (estrogen-containing) contraception can be safely used by midlife women who do not have cardiovascular risk factors. Unique noncontraceptive benefits for this population include: improvement in abnormal uterine bleeding, decreased hot flashes, and decreased cancer risk. Finally, guidelines state that contraception can be used by midlife women without medical contraindications until the age of menopause, at which time they may consider transition to systemic hormone therapy.

1Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA

2Department of Obstetrics and Gynecology, Warren Alpert Medical School of Brown University, Providence, RI

3Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL.

Address correspondence to: Taniqua A. Miller, MD, Emory University, Department of Gynecology and Obstetrics, 1365 Clifton Road NE, 4th Floor, Atlanta, GA 30322. E-mail:

Received 18 November, 2017

Revised 5 January, 2018

Accepted 5 January, 2018

Funding/support: None reported.

Financial disclosure/conflicts of interest: TAM—Emory University receives research funding from Medicines360 and Contramed. RHA—Nexplanon trainer for Merck; has also served as consultant for Bayer. AMK—Consultant, Bayer, Medicines360, Merck, Mithra, Pfizer. Research funds to University of Florida: Agile, Allergan, Bayer, Merck, Mithra. CAC—Emory University receives research funding from Medicines360 and Contramed.

© 2018 by The North American Menopause Society.