Contraception (birth control) is an important issue for every woman after the first menstrual period – called menarche – until the last menstrual period. While in the years between the first menstrual period and the age of 20 – the early reproductive phase – an unwanted pregnancy is usually a disaster, children between the ages of 25 and 35 are often part of life planning, although the timing is not always right. Pregnancies after the age of 40 are rare, but the complication rate for mother and child is considerably higher. In the early reproductive phase, safe contraceptive methods that can be reversed at any time are appropriate, such as hormonal contraception and condoms – in the sense of “safer sex” – in the age of AIDS and other diseases that can be transmitted through sexual intercourse – e.g. chlamydia and HPV. In middle reproductive age, in addition to hormonal contraception and the use of intrauterine devices (IUD), contraception can also be achieved with the help of basal body temperature measurement (BTM). From the age of 40, safe contraception is usually the focus of desire. The probability of becoming pregnant is about 30% for women between 40 and 44 years of age, with regular, unprotected sexual intercourse, and still 10% in the 45-49 age group. Perimenopause (transitional phase between premenopause and postmenopause; varying length of years before menopause – about five years – and after menopause (1-2 years); about 45-52 years): When selecting a contraceptive in perimenopause, it is important to keep in mind that in early perimenopause, a large proportion of cycles are still ovulatory; in mid- and late perimenopause, there are increased anovulatory cycles and periods of estrogen dominance. Many factors play a role in choosing the right method:
- Cyclical features – dysmenorrhea (menstrual cramps), premenstrual syndrome (discomfort before menstruation), bleeding disorders, etc.
- Diseases – e.g. obesity, hyperlipidemia (hyperlipoproteinemia; lipid metabolism disorders), diabetes mellitus, liver disease, diseases of the cholecystohepatic system (e.g. gallstones), thromboembolic events, diseases of the vascular system such as varicosis (varicose veins), hypertension (high blood pressure), etc.
- Health risks due to increased risk of thrombosis, smoking, etc.
- Condition after childbirth and breastfeeding phase
- Continuous medication – e.g., with barbiturates, anticonvulsants (drugs used to treat epileptic disorders ), sedatives (tranquilizers), tranquilizers (group of psychotropic drugs that have anxiety-relieving (anxiolytic) and relaxing (sedative) effects), and antipsychotics (neuroleptics/nerve depressants), as well as rifampicin and other antibiotics; analgesics, antirheumatic drugs, etc.
- Androgen disorders – seborrhea, acne (e.g. acne vulgaris).
The English Royal College for Obstetricians and Gynecologists recommends placing an intrauterine device, such as a copper or hormonal IUD, in women over 45 and leaving it in the uterus for seven years or longer. After age 50, use of ethinylestradiol-containing preparations should generally be avoided. Recommendations on various contraceptives for women with risks or underlying diseases (excerpted from [2))In bold, methods that can be used without restriction.
| Risk factor | KOK | POP | D/NE | LNG/ETG | CU-IUP | LNG-IUP |
| Age | ||||||
|
1 | 1 | 2 | 1 | 2 (< 20 yrs.) | 2 (< 20 yrs.) |
|
1 | 1 | 1 | 1 | 1 (< 20 yrs.) | 1 (< 20 yrs.) |
|
2 | 1 | 2 (> 45 yrs.) | 1 | 1 | 1 |
| Obesity | ||||||
|
2 | 1 | 1 | 1 | 1 | 1 |
| Smoking | ||||||
|
2 | 1 | 1 | 1 | 1 | 1 |
|
||||||
|
3 | 1 | 1 | 1 | 1 | 1 |
|
4 | 1 | 1 | 1 | 1 | 1 |
| Deep vein thrombosis (DVT)/pulmonary embolism (LE) | ||||||
|
4 | 2 | 2 | 2 | 1 | 2 |
|
4 | 3 | 3 | 3 | 1 | 3 |
| 4 | 2 | 2 | 2 | 1 | 2 | |
| Large operations | ||||||
|
4 | 2 | 2 | 2 | 1 | 2 |
|
2 | 1 | 1 | 1 | 1 | 1 |
| Minimal operations without immobilization | 1 | 1 | 1 | 1 | 1 | 1 |
| Hypertension (high blood pressure) | ||||||
|
3 | 1 | 2 | 1 | 1 | 1 |
|
4 | 2 | 3 | 2 | 1 | 2 |
|
4 | 2 | 3 | 2 | 1 | 2 |
| Multiple cardiovascular risk factors/comorbidities | ||||||
| z. E.g., older age, smoking, hypertension, diabetes mellitus. | 3/4 | 2 | 3 | 2 | 1 | 2 |
Legend
- COCs: combined oral contraceptives = combination oral, vaginal, or transdermal (combination of ethinylestradiol or estradiol[valerate] + progestin).
- POP: oral progestin monopreparation (lower cardiovascular risk).
- D: depot medroxyprogesterone acetate (DMPA).
- NE: norethisterone antate (depot progestogen).
- ETG: Etonogestrel implant (progestin implant).
- Cu-IUP: copper intrauterine device (copper IUD).
- LNG-IUP: levonorgestrel intrauterine device.
Recommendation
- 1: Method can be used without restriction.
- 2: Advantages of the method generally outweigh the disadvantages or risks.
- 3: Disadvantages or risks of the method generally outweigh the positive effects
- 4: Unacceptable health risk when using this method.
