May 2002 · Vol. 14, No. 5Managing perimenopause: the case for OCs
Perimenopausal patients—and their physicians—often view oral contraceptives with suspicion, believing the pills too risky for older women. But, the author argues, the evidence proves just the opposite.
PATRICIA
J.
SULAK,
MDDr. Sulak is professor of OBG, Texas A&M Health Science Center, and director of the division of ambulatory care and director of the sex education program at Scott and White Memorial Hospital in Temple, Tex. She also is an examiner for the American Board of Obstetrics and Gynecology and serves on OBG Management’s board of editors.
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Key points
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Among the many benefits oral contraceptives (OCs) offer perimenopausal women are effective contraception, a stable menstrual cycle, protection against ovarian and endometrial cancers, an easing of vasomotor symptoms, and prevention of bone loss.
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The World Health Organization (WHO) recently found that nonsmoking, normotensive, nondiabetic women who use OCs—at any age—face no increased risk of myocardial infarction compared with nonusers.
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OCs increase the risk of venous thrombosis from a baseline risk of less than 1 per 10,000 person-years in nonusers to 3 to 4 per 10,000 person-years in oral contraceptive users.
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If a perimenopausal patient is doing well on OCs, it is generally safe for her to continue taking them until the age of 55, by which time menopause has usually occurred.
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A 37-year-old patient who has been taking oral contraceptives (OCs) for several years announces during her annual exam that she wishes to discontinue them. Since she is nearing perimenopause—the 2 to 8 years leading up to the cessation of menses—she is concerned about adverse effects with long-term OC use. To prevent pregnancy, she plans to undergo tubal ligation.
With the new formulations available, women can safely take OCs until menopause occurs.
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