title: Oral contraception for women of middle age.
abstract: Women at middle age have decreased fertility and their pregnancies are higher risk. Combined oral contraceptives (COC) are effective but confer increased risk of age-related diseases, especially cardiovascular diseases. These risks are lower, however, with progestogen-only pills (POP). Therefore, other than the levonorgestrel intrauterine device (LNG-IUD), POP are usually the first choice, even though they do often lead to bleeding problems, which are already frequent in the perimenopause. However, the main risk of COC, venous thromboembolism, seems not to be relevant in (non-hospitalized) Chinese women and perhaps also other Asian women. COC may therefore be in fact a better choice than POP for these groups. In contrast to POP and IUDs, they have a variety of benefits especially important for middle-aged women, including a large decrease of the risk of ovarian, endometrial and colorectal cancer, an improvement in bleeding irregularities, a reduction of climacteric symptoms and some protection against bone loss. Further research is needed into individualized and safe contraception that takes into account ethnicity, as well as other factors.
authors.affiliation: Beijing Obstetrics & Gynecology Hospital, Capital Medical University, China; University Women's Hospital of Tuebingen, Germany.
authors.forename: Xiangyan
authors.initials: X
authors.lastname: Ruan
authors.affiliation: Beijing Obstetrics & Gynecology Hospital, Capital Medical University, China; University Women's Hospital of Tuebingen, Germany. Electronic address: Alfred.Mueck@med.uni-tuebingen.de.
authors.forename: Alfred O
authors.initials: AO
authors.lastname: Mueck
mesh_terms: D044466:Asian People; D003267:Contraception; D003277:Contraceptives, Oral, Combined / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D008875:Middle Aged; D047648:Perimenopause; D017410:Practice Guidelines as Topic; D011372:Progestins / Q000009:adverse effects / Q000627:therapeutic use*; D054556:Venous Thromboembolism / Q000139:chemically induced; D044465:White People
chemical_list: D003277:Contraceptives, Oral, Combined; D011372:Progestins; D016912:Levonorgestrel
keywords: Asia; Europe; Midlife; Oral contraception; Perimenopause