Contraceptive methods and issues around the menopause: an evidence update

Key content: There have been a number of recent advances and an increase in the number of contraceptive methods available to perimenopausal women. Other relevant issues, including transition to and diagnosis of menopause, the use of hormone replacement therapy with contraception, and when to stop contraception, are discussed. Some hormonal contraceptives have added benefits in the management of common perimenopausal gynaecological problems. Research and development into intrauterine contraception, microchip drug release technology, progesterone receptor modulators, male contraception and vaccines is currently underway. Learning objectives: Understand that, although women's natural fertility declines after their mid‐30s, effective contraception is required until menopause to prevent unintended pregnancies. Be aware that the risks of fetal chromosomal abnormalities, miscarriage, pregnancy complications and maternal morbidity and mortality increase for women aged 40 years and over. No contraceptive method is contraindicated on the basis of age alone. Clinicians must carefully consider comorbidities when prescribing women the most suitable contraception. Ethical issues: Return of fertility can be delayed for up to 1 year after discontinuing progestogen‐only injectable contraceptives; therefore, these contraceptives are not suitable for perimenopausal women considering future pregnancies. Contraceptive methods with a recognised post‐fertilisation, pre‐implantation effect may not be acceptable to some women. Women should be given information about all suitable contraceptive methods to make an informed choice.