Whenever try contraception no further necessary?
Advice concerning stopping contraception is summarised in Table 2.
Women that are not utilizing a hormone technique of contraception are encouraged to continue using contraception after their LMP for: 1
- one year if they’re elderly over half a century
- 2 years if they are elderly under 50 years.
Where timing of menopausal is actually unknown because of using contraception or HRT, people can continue using contraception until get older 55 and then prevent (spontaneous conception at this era is actually unusual regardless if a lady will continue to have menstrual bleeding). 1 If a female wishes to continue using a way of contraception for non-contraceptive grounds after get older 55 or menopausal, this could be evaluated on a person basis. 1 Intrauterine contraception shouldn’t be leftover in situ indefinitely as it could come to be a focus of disease, 1 or mistake the clinical image when the woman later on provides with post-menopausal bleeding.
The guideline promotes experts to evaluate and heal lady according to their unique disorders and requirements rather than their own serum hormone markers. 1 eg, a woman aged 53, amenorrhoeic with a 52 milligrams LNG-IUS inserted three years back for contraception and HMB could keep the product and have now they eliminated after age 55; there is no sign for hormonal evaluation. However, if needed, an individual FSH amount >30 IU/L in a woman over 50 is sufficient to confirm ovarian insufficiency and contraception tends to be ended 1 year later on. Progestogen-only ways of contraception usually do not prevent the menopausal rise in FSH levels. 1 FSH degrees are usually repressed in women making use of CHC or HRT and so are perhaps not for that reason scientifically of use. 1
Non-hormonal
Prevent contraception after two years of amenorrhoea
Stop contraception after 12 months of amenorrhoea.
Blended hormonal contraception
Could be continued
Take a look at get older 50 and change to a non-hormonal system or IMP/POP/LNG-IUS, subsequently follow suitable recommendations.
Progestogen-only injectable
Can be persisted
Ladies a‰?50 ought to be counselled concerning using choice strategies, next adhere proper information.
Progestogen-only implant (IMP)
Progestogen-only pill (POP)
Levonorgestrel intrauterine system (LNG-IUS)
Are continuing to age 50 and beyond
Stop at age 55 whenever normal reduction in fertility could be thought for many lady:
A Mirena LNG-IUS placed a‰?45 can stay in situ until get older 55 if utilized for contraception or hefty menstrual bleeding.
IMP=progestogen-only implant; POP=progestogen-only pill; LNG-IUS=levonorgestrel intrauterine program; FSH=follicle-stimulating hormone; IU=international unit
Reproduced with approval
Contraception and HRT
Sequential HRT just isn’t a powerful kind of contraception since it will not reliably control ovulation. 1 Women who try not to want to become pregnant should use contraception alongside HRT. Table 3 summarises the birth control solutions which you can use together with HRT.
Hormones replacement treatment may produce cyclical bleeding in postmenopausal women but it does not restore virility. Women that become post-menopausal don’t need to commence contraception when utilizing HRT, no matter if bleeding resumes. 1
Levonorgestrel intrauterine program (LNG-IUS)
Protected to use as contraception alongside oestrogen preference.
Mirena is actually approved for endometrial safety when along with oestrogen. It really is the just LNG-IUS authorized for this specific purpose.
It could be used up to 5 years for endometrial defense and requires become replaced regularly when used in this objective, despite years at installation.
Progestogen-only injectable
Safe to utilize as contraception alongside sequential HRT but consider switch to lower-dose progestogen-only approach.
Highly apt to be efficient for endometrial coverage with oestrogen as an element of HRT but is not recommended as unlicensed for this sign.
Progestogen-only enhancement (IMP)
Protected to make use of as contraception alongside sequential HRT.
Shouldn’t be ideal at the present time for endometrial defense within HRT as no facts to compliment effectiveness.
Progestogen-only supplement (POP)
Safe to utilize as contraception alongside sequential HRT.
Can not be ideal at the present time for endometrial protection included in http://www.datingranking.net/nl/tastebuds-overzicht HRT as no research to support efficacy.
Blended hormone contraception (CHC)
Do not use in combination with HRT.
Can be used in qualified females
Girls should-be urged to switch to a progestogen-only method of contraception at years 50; read above for approach alternatives because they relate to HRT.
LNG-IUS= l evonorgestrel intrauterine system; HRT=hormone substitution therapy; IMP=progestogen-only implant; POP= p rogestogen-only medicine; CHC=combined hormone contraception
Reproduced with approval