Perimenopause — Special Considerations

What makes perimenopause different

• You can still ovulate and get pregnant — contraception may still be needed until menopause is confirmed
• Hormone levels fluctuate unpredictably, making symptoms more variable
• Cyclical MHT can produce irregular bleeding and symptoms of estrogen excess

Contraception during perimenopause

Natural fertility declines steeply in the late 40s but does not reach zero until well after menopause. Unplanned pregnancy in perimenopausal women is more common than many realize and carries higher risks.

Contraceptive considerations:

• Hormonal IUD (e.g. Mirena): provides contraception AND can serve as the progestogen component of MHT
• Progestogen-only methods (pill, implant, injection) are safe for most perimenopausal women
• Combined oral contraceptive: provides contraception and controls irregular bleeding; masks the onset of natural menopause
• Copper IUD: non-hormonal contraception — effective but doesn’t help with menstrual irregularity
• Barrier methods: always an option but less effective statistically