Kontrazeption in der Perimenopause

Zusammenfassung

In der Perimenopause, der unmittelbaren Zeit vor der Menopause und in dem 1 Jahr danach, ist die Reproduktion noch nicht erloschen. Ovulationen können ohne Vorankündigungen auftreten und daher ist eine effektive Kontrazeption erforderlich, besonders wenn eine Schwangerschaft nicht mehr erwünscht ist. Keine kontrazeptive Methode ist nur allein durch das Alter kontraindiziert. Daher können die verschiedensten kontrazeptiven Methoden perimenopausalen Frauen empfohlen werden: orale hormonale Kontrazeptiva mit niedriger Ethinylestradioldosis, Gestagene (z. B. estrogenfreie orale hormonale Kontrazeptiva, injizierbare Depotgestagene, Hormonimplantate), das Intrauterinsystem mit Levonorgestrel, natürliche Estrogene in Kombination mit einem Gestagen, kupferhaltige IUP, Barrieremethoden oder die Tubensterilisation. Allerdings sollten die Frauen eine genaue individuelle Beratung über die Risiken und Nutzen der jeweiligen kontrazeptiven Methode erhalten. Die oralen hormonalen Kontrazeptiva mit Ethinylestradiol-Gestagen-Kombinationen sind eine sichere Option für alle gesunden Nichtraucherinnen mit normalem Blutdruck und fehlenden anderen Kontraindikationen bis zu 1 oder 2 Jahren nach der Menopause, da die Anwendung mit zahlreichen gesundheitlichen Vorteilen verbunden ist. Gestagenpräparate kommen für Frauen mit Kontraindikationen gegen Estrogene infrage. Die levonorgestrelhaltige Hormonspirale (Mirena®) ist die effektivste Methode zur Kontrazeption in der Perimenopause, auch für Frauen mit Zyklusstörungen. Für Zigarettenraucherinnen sind alle Estrogenkombinationspräparate ab dem 35. Lebensjahr aufgrund eines erhöhten kardiovaskulären Risikos absolut kontraindiziert.

Abstract

During perimenopause, the time immediately prior to and the first year after the last menstrual period, female reproductive capacity is low, but pregnancy is still possible. Ovulation may occur without warning and effective contraception is still necessary if pregnancy is not desired. There is no contraceptive method that is contraindicated due to age. Various contraceptive options may be offered to perimenopausal women, including oral contraceptives with low dosages of ethinylestradiol, vaginal ring, progestin pills, injectables, implants, intrauterine system with levonorgestrel, natural estrogen (estradiol) in combination with a progestin, intrauterine devices, barrier methods and tubal ligations. However, women need to receive accurate individual advice about the risks and benefits of each contraceptive method. Oral hormonal contraceptives are a safe option for healthy, normotonic non-smokers without any contraindications up until one or two years beyond menopause. In addition to the effective contraception, non-contraceptive benefits such as the treatment of bleeding disorders or dysmenorrhea play an important role. For women with contraindications against estrogens progestin-only methods (pills, injectables, implants) offer possible choices. The intrauterine system (IUS) with levonorgestrel remains the most effective contraceptive method, even in women with bleeding disorders. For smokers all estrogen-progestin combinations are contraindicated because of the known increased risk for cardiovascular disease.

Schlüsselwörter

Kontrazeption - Perimenopause

Key words

perimenopause - contraception

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