Contraception in the perimenopause

Background: The women of the so-called baby boomer generation are now entering the perimenopause period. During this period of life contraception is still needed. At the same time the first climacteric symptoms often need to be treated and consideration must be given to the risk profile. Objective: This article focuses on the question of which contraceptive methods are possible with respect to risks and specific benefits, e. g. relief of menopausal symptoms, which may occur during the perimenopause. Material and methods: A selective review of the literature was carried out. Results: In general, all types of contraception are possible; however, due to an increased rate of comorbidities a profound risk assessment is required. Combined methods of hormonal contraception are a therapeutic option, if the woman has no risk factors. An annual reevaluation of the individual situation is thus strongly recommended. Regimens with progesterone only are associated with less cardiovascular risks. Contraceptives containing only progestin and progestin-containing intrauterine devices should be preferred, since these products have fewer side effects than depot injections. Hormone-free contraceptive methods can be used unhesitatingly but they can be difficult to implement and have no effect on symptoms that often occur during the perimenopause or may even intensify them. Conclusion: A wide variety of contraceptive methods are possible during the perimenopause, but extra attention needs to be paid to comorbidities, existing risks factors and climacteric symptoms. Patients and treating doctors should keep in mind that symptoms may vary and adjustments of the contraception regimen to the needs are often necessary depending on the state of the perimenopause. © 2017, Springer Medizin Verlag GmbH.