Hormonal Contraception in Women of Older Reproductive Age

ArticleinNew England Journal of Medicine 358(12):1262-70 · April 2008with8 Reads
Impact Factor: 55.87 · DOI: 10.1056/NEJMcp0708481 · Source: PubMed
Abstract

A healthy, lean 46-year-old woman who is a nonsmoker requests advice about contraception. She notes that her menstrual periods are less regular than previously, and she also reports intermittent bothersome hot flashes. She is in a new relationship after a divorce, and she is sexually active. She asks if she can begin to use an oral contraceptive. What would you advise?

    • "...ic stroke [34]. Regardless of OC use, the absolute risk of stroke in reproductive-age women is low [32, 34]. Consensus-based recommendations regarding the use of ECHCs and stroke risk have been published..."
      Stroke and cardiovascular risks in women with migraine may relate to synergistic risk factors, including smoking, hypertension, diabetes, and hyperlipidemia [32, 34, 38], with smoking being the most prevalent modifiable risk factor for ischemic stroke [34]. Regardless of OC use, the absolute risk of stroke in reproductive-age women is low [32, 34]. Consensus-based recommendations regarding the use of ECHCs and stroke risk have been published [34, 39, 40].
    [Show abstract] [Hide abstract] ABSTRACT: Menstrual migraine and other hormonally related headaches are common in women. Falling estrogen levels or estrogen withdrawal after periods of sustained higher levels can trigger migraine. It makes sense to target this trigger for management of hormonally related headaches, particularly when nonhormonal strategies have been unsuccessful. Decision making regarding the use of hormonal contraception and menopausal hormone therapy is complex and commonly driven by other factors, but hormonal manipulation can potentially improve the course of migraine. Providers caring for migraineurs are appropriately concerned about stroke risk. Estrogen-containing hormonal contraceptives are relatively contraindicated for women who have migraine with aura. Postmenopausal hormone therapy is acceptable for women with a history of migraine. For these women, transdermal estradiol is recommended. Estrogen replacement is important for women who undergo an early menopause, whether natural or induced. Practical strategies for hormonal manipulation in the management of migraine and other hormonally related headaches are presented.
    Full-text · Article · Apr 2011 · Current Neurology and Neuroscience Reports
    0Comments 13Citations
    • "...available to help direct health care providers who care for women in their later reproductive years,78910 but factors that underlie older women's beliefs about, choices of, and use of various reversibl..."
      Nearly 20% of women aged 40-44 and 15% women aged 35-39 report no contraception use[6]. A plethora of review articles promoting the use of various reversible contraceptive methods are available to help direct health care providers who care for women in their later reproductive years,78910 but factors that underlie older women's beliefs about, choices of, and use of various reversible contraceptive methods are not well understood. Although many consider women in their later reproductive years as less fecund,[11] reasons for high rates of contraceptive non-use are not entirely clear.
    [Show abstract] [Hide abstract] ABSTRACT: More than 30% of the pregnancies in women aged 35 and over are unintended. This paper compares perceptions about contraceptive methods and use among women with and without an unintended pregnancy after turning age 35. Semi-structured, in-depth interviews were conducted with 17 women. They were all 35 to 49 years old, regularly menstruating, sexually active, not sterilized, not desiring a pregnancy in the near future, and at least 3 months postpartum. We purposely sampled for women who had had at least one unintended pregnancy after age 35 (n = 9) and women who did not (n = 8). We assessed partnership, views of pregnancy and motherhood, desired lifestyle, perceived advantages and disadvantages of using and obtaining currently available well-known reversible contraceptives in the U.S. ''We also assessed contraceptive methods used at any time during their reproductive years, including current method use and, if appropriate, circumstances surrounding an unintended pregnancy after age 35.'' Each interview was taped and transcribed verbatim. Data were analyzed using Grounded Theory. Analysis focused on partnership, views of pregnancy, motherhood, desired lifestyle and perceived advantages and disadvantages of various reversible contraceptive methods. The women without an unintended pregnancy after age 35 were more likely to (1) use contraceptive methods that helped treat a medical condition, (2) consider pregnancy as dangerous, or (3) express concerns about the responsibilities of motherhood. The women who experienced an unintended pregnancy after age 35 were more likely to (1) report unstable partnerships, (2) perceive themselves at lower risk of pregnancy, or (3) report past experiences with unwanted contraceptive side effects. There was a greater likelihood a woman would choose a contraceptive method if it was perceived as easy to use, accessible, affordable and had minimal side effects. Women's perspective on contraceptive use after age 35 varies. Public health messages and health providers' care can help women in this age group by reviewing their fertility risks, as well as all contraceptive methods and their associated side effects. The impact of such interventions on unintended pregnancy rates in this age group should be tested in other areas of evidence-based medicine.
    Full-text · Article · Feb 2011 · BMC Women's Health
    0Comments 8Citations
    • "...in combination with supraphysiologic progestins of variable androgenic activity to block ovulation [94]. The estrogenic components increase SHBG. ..."
      Oral contraceptives used by premenopausal women comprise supraphysiologic levels of estrogens in combination with supraphysiologic progestins of variable androgenic activity to block ovulation [94]. The estrogenic components increase SHBG.
    [Show abstract] [Hide abstract] ABSTRACT: Introduction.  Endocrine changes during aging as well as endocrine disorders may either directly or indirectly modulate female sexual function by altering sex hormones, or by impacting on vascular, neurogenic, or psychologic factors.Aim.  To review information on the impact of the hormonal changes associated with aging or those caused by endocrine disorders on female sexual function and current information on the risks and benefits of hormonal treatments.Methods.  Committee members outlined topics and reviewed the published literature on endocrine aspects of female sexual function over a 2-year period. Presentation of the recommendations were presented at the International Consultation on Sexual Medicine Paris, France 2009 and revised accordingly.Main Outcome Measures.  Quality of data published in the literature and recommendations were based on the GRADES system.Results.  Recommendations and guidelines concerning the role of sex hormones and endocrine disorders in female sexual function were derived.Conclusions.  Hormones are only one component of the many factors that contribute to normal sexual function in women. Further research is needed as to the impact of hormones and endocrine disorders on female sexual dysfunction and the benefits and risks of hormonal therapies. Wierman ME, Nappi RE, Avis N, Davis SR, Labrie F, Rosner W, and Shifren JL. Endocrine aspects of women's sexual function. J Sex Med 2010;7:561–585.
    Full-text · Article · Dec 2009 · Journal of Sexual Medicine
    0Comments 37Citations
  • Full-text · Article ·
    0Comments 0Citations
  • No preview · Article · Dec 2007 · Atención Primaria
    0Comments 1Citation
  • Preview · Article · Aug 2008 · Journal of Clinical Endocrinology & Metabolism
    0Comments 9Citations
Show more