CONTRACEPTION IN PERIMENOPAUSE - APPROACH IN PRIMARY CARE

Introduction/Objective: Perimenopause (PM) is a hormonal change period preceding the menopause. It extends from the beginning of menstrual irregularities up to one year of amenorrhea. Despite the decrease in fertility, the possibility of pregnancy and its complications make contraception essential. This revision aims systematize the contraception‘s approach in PM, creating a guide for Primary Care. Method: It was performed a research on Pubmed database of English and Portuguese publications (2004-2015), using the MeSH-terms: “Perimenopause”, “Contraception”, “Primary Health Care”. Results/Conclusions: The age isn’t a contraindication to use contraception. The benefits and risks should be weighed. The last are potentially exacerbated by common comorbidities. Hormonal methods, such as intrauterine system, have non-contraceptive benefits increasing quality of life. The suspension of contraception can be carried out ≥55 years, when it’s assumed the natural sterility. The suspension of combined hormonal contraception and injectable progestogen don‘t present consensus: some societies consider at 50 years, and others after diagnosis of menopause in the absence of adverse medical conditions. The measurement of follicle stimulating hormone for diagnosis of menopause and decision to suspend contraception is reserved for women under contraception only with progestogen, age ≥50 years, in amenorrhea and wishing to suspend it. The Family Physician (FP) should provide information about the possibility and risks of pregnancy in PM. FP should inform about most appropriate contraceptive options, according to comorbidities, empowering an informed choice. The proper suspension should also be addressed. FP plays a key role in systematic approach of this issue, in family planning.