FEATURES OF CONTRACEPTION IN WOMEN OF LATE REPRODUCTIVE AGE
Main Article Content
Abstract
The aim of this study was to conduct an analytical review of modern scientific publications about features of contraception in women of advanced maternity age.
Materials and methods. The analysis of 43 foreign and domestic literature sources on this topic has been carried out.
Results. Despite the decline in fertility, women in the period of menopausal transition need contraception. The methods of choice are intrauterine and hormonal contraception, as well as surgical sterilization. After 50 years, hormonal contraception can include only progestogen-containing drugs; to prevent bone loss, DMPA should be stopped. Contraceptive methods can have therapeutic non-contraceptive effects, but their prescription should be based on health and likely risk factors. Since the risk of pregnancy becomes extremely low when a woman reaches the age of 55, contraception can be stop at this age even in menstruating women.
Conclusion. Contraception in advanced maternity age has significant characteristics and should be recommended in accordance with the existing risk factors.
Keywords
Author Biographies
Наталья Владимировна Артымук,
Artymuk Natalia Vladimirovna
MD, PhD, professor, deputy editor of the journal Mother and Baby in Kuzbass.
She is the Head of the Department of Obstetrics and Gynaecology №2, the Deputy Editor-in-Chief. She is also the President of the Kemerovo regional public organization “Association of obstetricians and gynecologists”, the chief obstetrician-gynecologist of the Siberian Federal district; the member of the Board of the Russian Society of Obstetricians and Gynaecologists, the member of the European Society of Contraception and Reproductive Health, the European Society of Gynaecological Oncology and the International Society of Gynecological Endocrinology.
She has graduated from Kemerovo State Medical institute with honors. She studied in clinical residency in obstetrics and gynecology at School of Arenberg (Salzburg, Austria) and School of Bloomberg (Johns Hopkins University, Baltimore, USA). One is a specialist in ultrasound diagnostics in obstetrics and gynecology, endocrinology and endoscopic surgery. In 1996 in Barnaul she defended her PhD thesis and her doctoral thesis in 2003 in Moscow.
Her priorities are: endocrine gynecology, infertility, cervix uteri pathology, menopausal disorders, disorder of menstrual function, endoscopic and abdominal gynecological surgery.
She deals with reproductive health problems, non-surgical and surgical treatment of benign neoplasms of genital organs. She is an author of more than 450 scientific works, including 3 monographs and study manuals for doctors. She has her highest medical qualification category in “Obstetrics and gynecology”.
Ольга Анатольевна Тачкова,
candidate of medical sciences, docent, department of hospital therapy and clinical pharmacologyТатьяна Юрьевна Марочко,
candidate of medical sciences, docent, department of obstetrics and gynecology named after G.A. UshakovaArticle Details
Information about financing and conflict of interests
The authors declare that they have no apparent or potential conflicts of interest related to the publication of this article.
This work is licensed under a Creative Commons Attribution 4.0 License.
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References
U.S. Preventive Services Task Force. Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement (Draft). Available at: http://www.uspreventiveservicestaskforce.org/draftrec.htm. Accessed June 7, 2012
Harlow SD, Gass M, Hall JE et al. Executive summary of the Stages of Reproductive Aging Workshop+10: addressing the unfinished agenda of staging reproductive aging. Climacteric. 2012; 15: 105-114. http://gynendo.ru/wpcontent/uploads/2012/08/etapi_starenija_reproduct_sist_zhenschin_straw+10.pdf
Artymuk NV, Belokrinitskaya TE. Clinical norms. Obstetrics and gynecology. 2nd ed., revised and enlarged. M.: GEOTAR-Media, 2019. 272 p. Russian (Артымук Н.В. Белокриницкая Т.Е. Клинические нормы. Акушерство и гинекология. 2-е изд., перераб. и доп. М.: ГЭОТАР-Медиа, 2019. 272 с.)
Artymuk NV, Belokrinitskaya TE. Clinical norms. Obstetrics and gynecology. M.: GEOTAR-Media, 2018. 352 p. (Артымук Н.В., Белокриницкая Т.Е. Клинические нормы. Акушерство и гинекология. М.: ГЭОТАР-Медиа, 2018. 352 с.) https://www.rosmedlib.ru/book/ISBN9785970446546.html
National Institute for Health and Clinical Excellence. Menopause: Diagnosis and Management (NG23) 2015. Last updated 5 December 2019. https://www.nice.org.uk/guidance/ng23/resources/menopause-diagnosis-and-management-pdf-1837330217413
Hardman SMR, Gebbie AE. The contraception needs of the perimenopausal woman. Best Pract Res Clin Obstet Gynaecol. 2014; 28: 903-915
Santoro N, Crawford SL, El Khoudary SR et al. Menstrual cycle hormone changes in women traversing the menopause: study of women’s health across the nation. J Clin Endocrinol Metab. 2017; 22 March (Epub ahead of print). doi:10.1210/jc.2016-4017
Speroff L. The perimenopause: definitions, demography, and physiology. Obstet Gynecol Clin North Am. 2002; 29: 397-410
Vaninetti S, Baccarelli A, Romoli R et al. Effect of aging on serum gonadotropin levels in healthy subjects and patients with nonfunctioning pituitary adenomas. Eur J Endocrinol. 2000; 142: 144-149
Baldwin MK, Jensen JT. Contraception during the perimenopause. Maturitas. 2013; 76: 235-242
Klein J, Sauer MV. Assessing fertility in women of advanced reproductive age. Am J Obstet Gynecol. 2001; 185: 758-770
Nelson SM, Telfer EE, Anderson RA. The ageing ovary and uterus: new biological insights. Hum Reprod Update. 2013; 19: 67-83
Reproductive Endocrinology and Infertility Committee, Family Physicians Advisory Committee, Maternal-Fetal Medicine Committee, et al. Advanced reproductive age and fertility. J Obstet Gynaecol Can. 2011; 33: 1165-1175
Office for National Statistics. Conception Statistics, England and Wales, 2015. 2017. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/conceptionandfertilityrates/datasets/conceptionstatisticsenglandandwalesreferencetables
Faculty of Sexual & Reproductive Healthcare. FSRH Guideline: Contraception for Women Aged Over 40 Years. August 2017 (Amended September 2019) https://www.fsrh.org/standards-and-guidance/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/
Office for National Statistics. Opinions Survey Report No. 41: Contraception and Sexual Health, 2008/09. 2009. http://webarchive.nationalarchives.gov.uk/20160105160709/http://ons.gov.uk/ons/ rel/lifestyles/contraception-and-sexual-health/2008-09/index.html
Dratva J, Gómez Real F, Schindler C et al. Is age at menopause increasing across Europe? Results on age at menopause and determinants from two population-based studies. Menopause N Y N. 2009; 16: 385-394
Bayer Plc. Summary of Product Characteristics: Jaydess 13.5 mg intrauterine delivery system. 2016. https://www.medicines.org.uk/emc/medicine/28672
Royal College of Obstetricians and Gynaecologists (RCOG), British Society for Gynaecological Endoscopy. Management of Endometrial Hyperplasia (Green-top Guideline No. 67). 2016. https://www.rcog.org.uk/globalassets/documents/guidelines/green-top-guidelines/gtg_67_ endometrial_hyperplasia.pdf
Tepper NK, Whiteman MK, Marchbanks PA et al. Progestin-only contraception and thromboembolism: a systematic review. Contraception. 2016; 94: 678-700
Faculty of Sexual & Reproductive Healthcare (FSRH). Progestogen-only Injectable Contraception. 2014. http://www.fsrh.org/standards-and-guidance/documents/cec-ceu-guidance-injectables-dec-2014/
Faculty of Sexual & Reproductive Healthcare (FSRH). Progestogen-only Implants. 2014. http://www.fsrh.org/documents/cec-ceu-guidance-implants-feb-2014/
Bahamondes L, Valeria Bahamondes M, Shulman LP. Non-contraceptive benefits of hormonal and intrauterine reversible contraceptive methods. Hum Reprod Update. 2015; 21: 640-651
Varma R, Mascarenhas L. Endometrial effects of etonogestrel (Implanon) contraceptive implant. Curr Opin Obstet Gynecol. 2001; 13: 335-341
Walch K, Unfried G, Huber J, et al. Implanon versus medroxyprogesterone acetate: effects on pain scores in patients with symptomatic endometriosis – a pilot study. Contraception. 2009; 79: 29-34
FSRH Clinical Guideline: Combined Hormonal Contraception (January 2019, Amended 2019)
Roach REJ, Helmerhorst FM, Lijfering WM et al. Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke. Cochrane Database Syst Rev. 2015; 8: CD011054
Peragallo Urrutia R, Coeytaux RR, McBroom AJ et al. Risk of acute thromboembolic events with oral contraceptive use: a systematic review and meta-analysis. Obstet Gynecol. 2013; 122: 380-389
Lidegaard Ø, Løkkegaard E, Jensen A et al. Thrombotic stroke and myocardial infarction with hormonal contraception. N Engl J Med. 2012; 366: 2257-2266
Poulter N, Chang C, Meirik O et al. Haemorrhagic stroke, overall stroke risk, and combined oral contraceptives: results of an international, multicentre, case-control study. WHO Collaborative Study of Cardiovascular Disease and Steroid Hormone Contraception. Lancet. 1996; 348: 505-510
Yang L, Kuper H, Sandin S et al. Reproductive history, oral contraceptive use, and the risk of ischemic and hemorrhagic stroke in a cohort study of middle-aged Swedish women. Stroke. 2009; 40: 1050-1058
Weill A, Dalichampt M, Raguideau F et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ. 2016; 353: i2002
Dinger J, Möhner S, Heinemann K. Cardiovascular risks associated with the use of drospirenone-containing combined oral contraceptives. Contraception. 2016; 93: 378-385
Baillargeon J-P, McClish DK, Essah PA et al. Association between the current use of low-dose oral contraceptives and cardiovascular arterial disease: a meta-analysis. J Clin Endocrinol Metab. 2005; 90: 3863-3870
Lopez LM, Grimes DA, Gallo MF et al. Skin patch and vaginal ring versus combined oral contraceptives for contraception. Cochrane Database Syst Rev. 2013; 4: CD003552
Nelson HD, Zakher B, Cantor A et al. Risk factors for breast cancer for women aged 40 to 49 years: a systematic review and meta-analysis. Ann Intern Med. 2012; 156: 635-648
Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53297 women with breast cancer and 100239 women without breast cancer from 54 epidemiological studies. Lancet. 1996; 347: 1713-1727
Baber RJ, Panay N, Fenton A, and the IMS Writing Group. 2016 IMS Recommendations on women’s midlife health and menopause hormone therapy. Climacteric. 2016; 19(2). DOI: 10.3109/13697137.2015.1129166
Zhu H, Lei X, Feng J et al. Oral contraceptive use and risk of breast cancer: a meta-analysis of prospective cohort studies. Eur J Contracept Reprod Health Care. 2012; 17: 402-414
Poosari A, Promthet S, Kamsa-ard S et al. Hormonal contraceptive use and breast cancer in Thai women. J Epidemiol Community Health. 2014; 24: 216-220
Gierisch JM, Coeytaux RR, Urrutia RP et al. Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer Epidemiol Biomarkers Prev. 2013; 22: 1931-1943
Vessey M, Yeates D. Oral contraceptive use and cancer: final report from the Oxford-Family Planning Association contraceptive study. Contraception. 2013; 88: 678-683
Gebbie AE, Glasier A, Sweeting V. Incidence of ovulation in perimenopausal women before and during hormone replacement therapy. Contraception. 1995; 52: 221-222