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Advising perimenopausal women about contraception

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Women's fertility may decline once they reach their mid-30s, but contraception still needs to be considered if a woman is sexually active. Older women, who may be starting new relationships after being with the same partner for many years, might need additional support regarding contraception, as well as education on sexually transmitted infections.1 It is worth discussing emergency contraception with older women who may be unaware of how to access this or the time periods within which it can be used after having had unprotected sex.

Although no method of contraception is contraindicated on age alone, increasing age can be associated with an increased risk of concurrent medical conditions that might impact on contraceptive choice.1 Contraceptive advice for all women should be tailored to the individual by taking a thorough medical history as well as assessing any plans for having a family and the risk of sexually transmitted infections. The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) may be helpful in considering contraceptive choices for women over 40 years of age,1 although patient preference and clinical judgement need to be taken into account.

The menopause is a retrospective clinical diagnosis which can be confirmed after one year of amenorrhoea.1 Perimenopausal women in their 40s and 50s may present with less frequent and irregular periods.

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