为40岁以上的女性选择避孕方法有时很困难,但这是至关重要的,因为生育和怀孕的风险仍然存在。这需要对形势进行彻底的评估,为了确定任何血管和代谢危险因素,以及已经诊断出的子宫和乳腺良性病变。
本综述的目的是为40岁以上女性的避孕处方制定一些临床实践指南。
对法国和英国现有文献进行了系统的回顾。Pubmed和Cochrane库用于确定有关围绝经期妇女避孕的研究。还审查了科学协会发布的国际准则(RCOG,FSRH,ESHRE,ACOG,WHO,HAS).
没有单独基于年龄的避孕方法是禁忌的。然而,因为年龄是血管和代谢性疾病的危险因素,激素避孕和DMPA联合用药不应在初次使用时使用.铜宫内节育器和仅孕激素的避孕药(药丸,植入物,宫内节育器)应主要考虑,因为它们提供了良好的疗效和较低的风险。
40岁以上女性的避孕不应该被搁置。长效可逆避孕和仅含孕激素的药丸必须作为第一处方。50岁以上使用非激素避孕的女性不再需要避孕,经过12个月的闭经。接受联合激素避孕治疗的患者必须在50岁以上停止使用。不建议在使用激素避孕时测量激素水平。必须考虑无荷尔蒙避孕间隔,同时使用屏障避孕方法。如果卵巢活动持续,应(重新)建立非激素避孕或仅孕激素避孕(DMPA除外)。
Choosing contraception for women over 40 can be sometimes difficult but it is crucial since fertility and pregnancy\'s risks still exist. It requires a thorough evaluation of the situation, in order to identify any vascular and metabolic risk factors, along with the uterine and mammary benign pathologies already diagnosed.
The objective of this review was to elaborate some
guidelines for clinical practice regarding contraception\'s prescription for women over 40.
A systematic review of the French and English existing literature was conducted. Pubmed and the Cochrane library were used to identify studies about contraception for perimenopausal women. International
guidelines published by scientific societies were also reviewed (RCOG, FSRH, ESHRE, ACOG, WHO, HAS).
No contraceptive methods are contraindicated on the sole basis of age alone. However, because age is a risk factor for vascular and metabolic diseases, combined hormonal contraception and DMPA should not be prescribed at first intention. Copper IUD and progestin-only contraceptives (pill, implant, intrauterine device) should primarily be considered, since they offer good efficacy with lower risks.
Contraception for women over 40 should not be put aside. Long acting reversible contraception and progestin-only pill have to be prescribed as first-ine. Contraception is no longer needed for women over 50 who use non-hormonal contraception, after a 12 month-amenorrhea. Patients treated with combined hormonal contraception must stop using it over 50. Measuring hormonal levels while using hormonal contraception is not recommended. An hormonal-contraception-free interval must be considered, while using barrier contraception method. If an ovarian activity persists, a non-hormonal contraception or progestin-only contraception (except for DMPA) should be (re-)established.