title: Contraception and family planning at the extreme of reproductive life - climacteric.
abstract: Menopause is an endocrine phenomenon characterized by gradual estrogen decline. This is a stage in a woman's life in which contraception is extremely important as the risks associated with pregnancy and childbirth increase, both maternal issues associated with higher incidence of comorbidities and issues related to fetal abnormalities, mitochondrial abnormalities, or genetic syndromes. On the other hand, there is a growing number of women who have postponed motherhood and need effective contraception, but without prolonging the return to fertility. Long-acting reversible contraceptives (LARCs), low-dose oral hormonal contraceptives and non-oral contraceptives are preferred. The levonorgestrel-releasing intrauterine system is a very good alternative that can maintain endometrial protection after menopause. Definitive methods such as tubal ligation and vasectomy are options for couples that already have their offspring. In this review, we present evidence for contraceptive indication and the effects of hormonal methods on climacteric including options for contraception, control of bleeding during perimenopause and of climacteric symptoms, as well as the transition from such methods to hormone therapy if indicated.
authors.affiliation: PhD - Coordinator of the Sector of Family Planning and Adjunct Professor of the Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil.
authors.forename: Zsuzsanna Ilona Katalin de Jármy
authors.initials: ZI
authors.lastname: Di Bella
authors.affiliation: PhD - Graduate Student, Department of Gynecology, EPM-Unifesp, São Paulo, SP, Brazil.
authors.forename: Ana Maria Homem de Mello
authors.initials: AM
authors.lastname: Bianchi
authors.affiliation: PhD - Coordinator of the Sector of Family Planning, and Affiliate Professor of the Department of Gynecology, EPM-Unifesp, São Paulo, SP, Brazil.
authors.forename: Fabio Fernando de
authors.initials: FF
authors.lastname: Araujo
authors.affiliation: MD - Associated Professor of the Department of Gynecology, EPM-Unifesp, São Paulo, SP, Brazil.
authors.forename: Marair Gracio Ferreira
authors.initials: MG
authors.lastname: Sartori
authors.affiliation: PhD - Professor, Habilitation (BR: Livre-docência) - Full Professor of the Department of Gynecology, EPM-Unifesp, São Paulo, SP, Brazil.
authors.forename: Manoel João Batista Castello
authors.initials: MJ
authors.lastname: Girão
mesh_terms: D000367:Age Factors; D003267:Contraception / Q000379:methods*; D003271:Contraceptive Agents, Female / Q000627:therapeutic use; D005193:Family Planning Services / Q000379:methods*; D005260:Female; D006801:Humans; D008593:Menopause / Q000502:physiology*; D012098:Reproduction / Q000502:physiology*; D012307:Risk Factors; D013997:Time Factors
chemical_list: D003271:Contraceptive Agents, Female