Contraception in Perimenopause: An Evidence-based Review

Introduction: The perimenopause is a complicated stage in a woman’s life with medical implications such as progressive hormonal changes, fluctuating ovarian activity, and the gradual cessation of menstruation. Although the fertility range declines significantly during the perimenopausal period, as a result of possible ovulation until the final menstrual period, women may lead to unintended pregnancies. Such pregnancies can be categorised as high risk, as they may be associated with hypertensive disorders, gestational diabetes, miscarriage, and chromosomal abnormalities such as Down syndrome.

Methods: This narrative review was conducted through a desk-based analysis of published and grey literature related to contraception in perimenopause. Sources included peer-reviewed journal articles, policy documents, reports, and relevant legal and institutional texts. The review synthesised evidence to identify key themes, gaps, and implications for sexual and reproductive health in the Sri Lankan and South Asian context.

Results: Perimenopausal women often experience a range of symptoms such as vasomotor disturbances, abnormal uterine bleeding, mood changes, sleep disruptions, and alterations in sexual function that may considerably affect their quality of life. Hormonal contraception during this period offers a unique dual benefit: effective pregnancy prevention and therapeutic management of many perimenopausal symptoms. This review provides a broad and complete discussion of the use of contraception during the perimenopausal period. It further examines the physiological background of perimenopause, the rationale for contraception, and the vast array of available methods. Each method used in this particular review is evaluated based on its effectiveness, safety, suitability for symptom relief, and potential non-contraceptive health benefits, such as cancer risk reduction and bone density preservation. Coexisting health conditions, transition to menopause hormone therapy, and the unique needs of women with premature ovarian insufficiency are addressed as special considerations.

Conclusion: Contraception in perimenopause is vital to prevent unintended pregnancies and offers added health benefits. Individualised method selection and effective counselling are key to ensuring safety, autonomy, and improved quality of life for women during this transition.