2020, Número S1
<< Anterior Siguiente >>
Ginecol Obstet Mex 2020; 88 (S1)
Anticoncepción en la premenopausia
Blümel JE, Vallejo MS
Idioma: Español
Referencias bibliográficas: 54
Paginas: 109-120
Archivo PDF: 225.57 Kb.
RESUMEN
Después de los 40 años, la mujer entra en un periodo en el que puede haber dos
condiciones reproductivas diferentes. Primera, si bien su fertilidad disminuye paulatinamente,
mantiene un riesgo de embarazo latente. Segunda, el lento declinar de la
función ovárica provoca cambios en las concentraciones de las hormonas sexuales.
Frente a esta problemática, tanto el médico como la paciente deben considerar el uso
de métodos anticonceptivos. Si bien el periodo premenopáusico puede asociarse con
pérdida de la libido, la mayoría de las mujeres siguen siendo sexualmente activas y
necesitarán algún método anticonceptivo si no desean embarazarse. Es verdad que
la fertilidad disminuye significativamente con la edad y conforme ésta avanza, las
mujeres tienen menos probabilidad de embarazarse, pero aún así están en un riesgo
alto de embarazo. Aunque la fertilidad disminuye con la edad, el porcentaje de
embarazos no deseados en las mujeres premenopáusicas (40%) no es diferente a las
cifras observadas en mujeres más jóvenes. Ese riesgo de embarazo en las mujeres
mayores de 40 años traduce una serie de percepciones erradas, tanto en las mismas
mujeres como en los médicos. Erróneamente se piensa que las mujeres en el climaterio
tienen muy baja fertilidad y no requieren, por lo tanto, una anticoncepción
efectiva. Además, que los anticonceptivos hormonales implican un alto riesgo de
efectos indeseados en este grupo etario, sobre todo trombóticos. Sin embargo, estas
conductas no consideran que los anticonceptivos actuales, por sus bajas dosis, no
implican mayores riesgos. Tampoco se consideran los riesgos que implica el embarazo
en la mujer mayor.
REFERENCIAS (EN ESTE ARTÍCULO)
Mendoza N, et al. Do women aged over 40 need different counseling on combined hormonal contraception? Maturitas 2016;87:79-83. https://doi.org/10.1016/j. maturitas.2016.02.008.
Finer LB, et al. Trends in ages at key reproductive transitions in the United States, 1951-2010. Women’s Health 34. Colquitt CW, et al. Contraceptive Methods. J Pharm Pract 2017;30:130-35. https://doi.org/10.1177/0897190015585751 35. Linton A, et al. Contraception for the perimenopausal woman. Climacteric 2016;19:526-34. https://doi.org/10. 1080/13697137.2016.1225033 36. Stephen Searle E. The intrauterine device and the intrauterine system. Best Pract Res Clin Obstet Gynaecol 2014;28:807-24. https://doi.org/10.1016/j.bpobgyn. 2014.05.004. Issues 2014;24:e271-9. https://doi.org/10.1016/j. whi.2014.02.002.
Mercer CH, et al. Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet 2013;382(9907):1781-94. https://doi. org/10.1016/S0140-6736(13)62035-8.
Steiner AZ, et al. Impact of female age and nulligravidity on fecundity in an older reproductive age cohort. Fertil Steril 2016;105:1584-8. https://doi.org/10.1016/j.fertnstert. 2016.02.028.
Gray RH. Biological and social interactions in determination of late fertility. J Biosoc Sci 1979;(Suppl 6):97-115.
Guttmacher Institute, 2014. Unintended Pregnancy in the United States: Factsheet. https://www.guttmacher.org/ united-states/pregnancy/unintended-pregnancy.
Hardman SM, et al. The contraception needs of the perimenopausal woman. Best Prac Res Clin Obst Gyn 2014;28:903- 15. https://doi.org/10.1016/j.bpobgyn.2014.05.006.
Ogawa K, et al. Association between very advanced maternal age and adverse pregnancy outcomes: a cross sectional Japanese study. BMC Pregnancy Childbirth 2017;17:349. https://doi.org/10.1186/s12884-017-1540-0.
Khalil A, et al. Maternal age and adverse pregnancy outcome: a cohort study. Ultrasound Obstet Gynecol 2013;42:634-43. 10.1002/uog.12494.
Skjeldestad FE. Choice of contraceptive modality by women in Norway. Acta Obstet Gynecol Scand 1994;73(1):48-52.
Mishell DR. Use of oral contraceptives in women of older reproductive age. J Am J Obstet Gynecol 1988;158(6 Pt 2):1652-7.
Shaaban MM. The perimenopause and contraception. Maturitas 1996;23:181-92.
Blümel JE, et al. Collaborative Group for Research of the Climacteric in Latin America (REDLINC). Menopausal symptoms appear before the menopause and persist 5 years beyond: a detailed analysis of a multinational study. Climacteric 2012;15:542-51. https://doi.org/10.3109/13 697137.2012.658462
Larson B, et al. Urogenital and vasomotor symptoms in relation to menopausal status and the use of hormone replacement therapy (HRT) in healthy women during transition to menopause. Maturitas 1997;28:99-105.
McKinlay SM. The normal menopause transition: an overview. Maturitas 1996;23:137-45.
World Health Organization, 2015. Medical eligibility criteria for contraceptive use, 5th Ed. https://www.who. int/reproductivehealth/publications/family_planning/ MEC-5/en/
Nightingale AL, et al. The effects of age, body mass index, smoking and general health on the risk of venous thromboembolism in users of combined oral contraceptives. Eur J Contracept Reprod Health Care 2000;5:265-74.
Graziottin A. Contraception containing estradiol valerate and dienogest--advantages, adherence and user satisfaction. Minerva Ginecol 2014;66:479-95.
Blümel JE, et al. A scheme of combined oral contraceptives for women more than 40 years old. Menopause 2001;8:286-9.
Dombrowski S, et al. Oral contraceptive use and fracture risk-a retrospective study of 12,970 women in the UK. Osteoporos Int 2017;28:2349-55. https://doi.org/10.1007/ s00198-017-4036-x.
Lopez LM, et al. Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev 2014;(6):CD006033. https://doi.org/10.1002/14651858. CD006033.pub5.
Nappi C, et al. Hormonal contraception and bone metabolism: a systematic review. Contraception 2012;86:606-21. https://doi.org/10.1016/j.contraception.2012.04.009.
Hannaford PC, et al. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners' Oral Contraception Study. BMJ 2010;340:c927. https://doi.org/10.1136/bmj.c927.
Charlton BM, et al. Oral contraceptive use and mortality after 36 years of follow-up in the Nurses' Health Study: prospective cohort study. BMJ 2014;349:g6356. https:// doi.org/10.1136/bmj.g6356.
James AH. Pregnancy-associated thrombosis. Hematol Am Soc Hematol Educ Program 2009;277-85. https://doi. org/10.1182/asheducation-2009.1.277.
de Bastos M, et al. Combined oral contraceptives: venous thrombosis. Cochrane Database Syst Rev 2014;3:CD010813. 10.1002/14651858.CD010813.pub2.
Hannaford PC, et al. Cancer risk among users of oral contraceptives: cohort data from the Royal College of General Practitioner's oral contraception study. BMJ 2007;335(7621):651. https://doi.org/10.1136/ bmj.39289.649410.55
Moorman PG, et al. Oral contraceptives and risk of ovarian cancer and breast cancer among high-risk women: a systematic review and meta-analysis. J Clin Oncol 2013;31:4188- 98. https://doi.org/10.1200/JCO.2013.48.9021
Samplaski MK, et al. Vasectomy as a reversible form of contraception for select patients. Can J Urol 2014;21:7234-40.
Kirby EW, et al. Vasectomy reversal: decision making and technical innovations. Transl Androl Urol 2017;6:753-60. https://doi.org/10.21037/tau.2017.07.22.
Serfaty D. Contraception during perimenopause: The spermicides option. J Gynecol Obstet Hum Reprod 2017;46:211- 218. https://doi.org/10.1016/j.jogoh.2016.10.007.
Chan LM, et al. Tubal sterilization trends in the United States. Fertil Steril 2010;94:1-6. https://doi.org/10.1016/j. fertnstert.2010.03.029.
Patil E, et al. Update on permanent contraception options for women. Curr Opin Obstet Gynecol 2015;27:465-70. https://doi.org/10.1097/GCO.0000000000000213.
Colquitt CW, et al. Contraceptive Methods. J Pharm Pract 2017;30:130-35. https://doi.org/10.1177/0897190015585751
Linton A, et al. Contraception for the perimenopausal woman. Climacteric 2016;19:526-34. https://doi.org/10. 1080/13697137.2016.1225033
Stephen Searle E. The intrauterine device and the intrauterine system. Best Pract Res Clin Obstet Gynaecol 2014;28:807-24. https://doi.org/10.1016/j.bpobgyn. 2014.05.004.
Cantero Pérez P, et al. Contraception during the perimenopause: indications, security (safety), and noncontraceptive benefits. Rev Med Suisse 2015;11:1988-92.
Tepper NK, et al. Progestin-only contraception and thromboembolism: A systematic review. Contraception 2016;94:678-700. https://doi.org/10.1016/j.contraception. 2016.04.014.
Nelson AL. Perimenopause, menopause and post menopause: health promotion strategies. In: Hatcher RA, et al, Editors. Contraceptive technology. 20th ed. Atlanta: Bridging the Gap Communications, 2011;737-68.
Grimes DA, et al. Progestin-only pills for contraception. Cochrane Database Syst Rev 2013;11:CD007541. https:// doi.org/10.1002/14651858.CD007541.pub3.
de Melo NR. Estrogen-free oral hormonal contraception: benefits of the progestin-only pill. Womens Health (Lond) 2010;6:721-35. https://doi.org/10.2217/whe.10.36.
Long ME, et al. Contraception and hormonal management in the perimenopause. J Women’s Health (Larchmt) 2015;24:3-10. https://doi.org/10.1089/jwh.2013.4544.
Jacobstein R, et al. Progestin-only contraception: injectables and implants. Best Pract Res Clin Obstet Gynaecol 2014;28:795-806. https://doi.org/10.1016/j. bpobgyn.2014.05.003.
Funk S, et al. Safety and efficacy of Implanon, a singlerod implantable contraceptive containing etonogestrel. Contraception 2005;71:319-26. https://doi.org/10.1016/j. contraception.2004.11.007
Batista GA, et al. Body composition, resting energy expenditure and inflammatory markers: impact in users of depot medroxyprogesterone acetate after 12 months follow-up. Arch Endocrinol Metab 2017;61:70-75. https:// doi.org/10.1590/2359-3997000000202.
Lopez LM, et al. Steroidal contraceptives: effect on bone fractures in women. Cochrane Database Syst Rev 2014;(6):CD006033. https://doi.org/10.1002/14651858. CD006033.pub5.
Kyvernitakis I, et al. The impact of depot medroxyprogesterone acetate on fracture risk: a case-control study from the UK. Osteoporos Int 2017;28:291-97. https://doi. org/10.1007/s00198-016-3714-4.
Wildemeersch D. Why perimenopausal women should consider to use a levonorgestrel intrauterine system. Gynecol Endocrinol 2016;32:659-61. 10.3109/09513590.2016.1153056
Cooper DB, et al. Oral Contraceptive Pills. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Oct 27.
Shulman LP. The state of hormonal contraception today: benefits and risks of hormonal contraceptives: combined estrogen and progestin contraceptives. Am J Obstet Gynecol 2011;205(Suppl 4):S9-S13. https://doi.org/10.1016/j. ajog.2011.06.057.
Farris M, et al. Pharmacodynamics of combined estrogenprogestin oral contraceptives: 2. effects on hemostasis. Expert Rev Clin Pharmacol 2017;10:1129-44. https://doi. org/10.1080/17512433.2017.1356718.
Bastianelli C, et al. Pharmacodynamics of combined estrogen-progestin oral contraceptives: 1. Effects on metabolism. Expert Rev Clin Pharmacol 2017;10:315-26. https:// doi.org/10.1080/17512433.2017.1271708.
Edelman A, et al. Continuous or extended cycle vs cyclic use of combined hormonal contraceptives for contraception. Cochrane Database Syst Rev 2014;7:CD004695. https:// doi.org/10.1002/14651858.CD004695.pub3.
Speroff L. Clinical guidelines for contraception at different ages: early and late. In: Speroff L, Darney PD. A clinical guide for contraception. Philadelphia: Lippincott Williams & Wilkins, 2011;351-79.