Hormonal Contraceptives

Premenopausal women
Define premenopausal or perimenopausal
• Premenopausal or Perimenopause often used interchangeably, is
defined as the phase in a woman’s life immediately before
menopause and the first year following menopause in which the
endocrinological, biological and clinical changes of the approaching
menopause become apparent. Falsely, the term “menopausal
transition” has been used as a synonym for perimenopause in the
past few years
(Kunnaiah, 2015)
Define premenopausal or perimenopausal
continued..
• Premenopausal (climatric) period is the transitional phase of female
reproductive life that precedes menopause, generally happens
around 40 – 50 years age. It usually occurs 3-4 yrs before menopause.
• As a woman enters into this period, the number and quality of her
eggs in the ovaries begins to decline, which is called as involution of
the ovary; this results in reduced levels of estrogen and progesterone.
(Kunnaiah, 2015)
Two main types of hormonal contraceptives

• Short Acting Hormonal Methods: These are hormone methods used

to regulate or stop ovulation and prevent pregnancy.Hormones can
be introduced into the body through various methods, including pills,
injections, skin patches, transdermal gels, vaginal rings, intrauterine
systems, and implantable rods. Depending on the types of hormones
that are used, these methods can prevent ovulation; thicken cervical
mucus, which helps block sperm from reaching the egg; or thin the
lining of the uterus.
Short-acting hormonal methods (e.g., injectables, pills, patches, rings)
are effective if used perfectly, but in typical use, the failure rates are
7% to 9%. (national institute of child health and human development,
2017)
Two main types of hormonal contraceptives
• Combined Hormonal Methods these method contains a synthetic
estrogen (ethinyl estradiol) and one of the many progestin approved
in the United States. All of the products work by inhibiting ovulation
and thickening cervical mucus. The combined estrogen/progestin
drugs can be delivered by pills, a patch, or a vaginal ring.
• (national institute of child health and human development, 2017)
Two main types of hormonal contraceptives
Combined Hormonal Methods
 Combined oral contraceptives (COCs, "the pill").
 Contraceptive patch
 Vaginal ring.

Short-Acting Hormonal Methods

 Injectable birth control
 Progestin-only pills (POPs)
(national institute of child health and human development, 2017)
Combined Hormonal Methods(Combined oral
contraceptives) and preMenopause
The combined pill can safely be used until the age of 50, as long as
there are no health risks such as smoking, obesity, high blood pressure
etc that could lead to heart, stroke or blood clotting problems.
The pill has several advantages in premenopausal women these
include: regulating periods maintenance of bone mineral density
(which is reduced after the menopause), reduce blood loss and period
pains and may also relieve some troublesome menopausal symptoms
such as hot flushes and night sweats(Womens-health-concern.org,
2017)
Combined Hormonal Methods(Contraceptive
Patch and Vaginal Ring) and preMenopause
The efficacy, benefits and risk are similar to the combined pill and again
can be safely prescribed until 50 years old to those with no health risks.

(Womens-health-concern.org, 2017)
Short Acting Hormonal Contraceptives
(injectable birth control) and premenopause
• Use of this method may continue until the age of 50. There has been
some concern that the injection may reduce bone mineral density
and increase the risk of osteoporosis. Women who have lifestyle or
risk factors for osteoporosis (smokers, previous fractures, steroid use,
family history etc) may wish to consider another method of
contraception. (Womens-health-concern.org, 2017)
Short Acting Hormonal Contraceptive(Progestogen
only pill) and Premenopause
• Progestogen-only methods
• All progestogen-only methods may cause irregular bleeding or even
no bleeding at all. The absence of bleeding doesn’t necessarily mean
that the menopause has been reached – it is just a side effect of the
method of contraception. Medical advice should be sought if bleeding
occurs after a long time with no periods.
• The progestogen-only pill (POP or mini-pill)
• The progestogen-only pill is suitable for older women and can safely
be used up until the age of 55.
(Womens-health-concern.org, 2017)
Hormonal Contraceptives general risk in
premenopausal women may cause:
1.cholesterol levels alterations:
The estrogen is said to increase HDL "good" cholesterol and decreasing
LDL "bad" cholesterol. Progestin may cause "good" cholesterol to lower
and "bad" cholesterol to rise. Since there is decreased amount of
estrogen presented in premenopausal women it may allow an increase
in LDL. though this may increase these changes in blood levels are not
strong enough to have a poor effect on your health. (Mohei Abouzied,
2016)
Hormonal Contraceptives and premenopausal
women may cause
2. Blood clots in the veins in your legs:
.Blood coagulation capacity increases with age in healthy individuals.
As the body age the ability for the blood to coagulate decreases
gradually which gives rise to phenomenon associated with increased
cardiovascular diseases and thrombosis thus making premenopausal
women more susceptible. These can become life threatening if the
blood clots leave your legs and travel into you lungs. The risk of blood
clots is increased more in people who smoke. (Mohei Abouzied, 2016)
Hormonal Contraceptives and premenopausal
women may cause
3 cardiovascular diseases
Women aged 35 or older who smoke heavily and take birth control pills
have an increased risk of having a heart attack or stroke. This is because
nicotine causes blood pressure to rise and heart rate to accelerate.
The pill adds more stress to the blood vessels because of the extra
estrogen. (Mohei Abouzied, 2016)
• Kunnaiah, D. (2015). PREMENOPAUSAL (CLIMATRIC) PROBLEMS AND SOLUTIONS | Continental
Hospitals Blog.Continental Hospitals Blog. Available at:
http://www.continentalhospitals.com/blog/premenopausal-climatric-problems-and-
solutions/#.WnefH-jwbIU
• Kaunitz, A. (2017). Uptodate.com. Available at: https://www.uptodate.com/contents/hormonal-
methods-of-birth-control-beyond-the-basics
• Womens-health-concern.org. (2017). Contraception for the older woman. Available at:
https://www.womens-health-concern.org/_wpress/wp-content/uploads/2015/02/WHC-
FACTSHEET-ContraceptionForTheOlderWoman-NOV17.pdf
• national institute of child health and human development. (2017). What are the different types of
contraception?.Available at:
https://www.nichd.nih.gov/health/topics/contraception/conditioninfo/types
•