Contraception and Hormone Therapy in Perimenopause

Risks and Considerations

• The U.S. Preventive Services Task Force recommends against using combined estrogen and progestin for prevention of chronic conditions in postmenopausal women (Grade D recommendation) 1, 2
• For every 10,000 women taking combined estrogen and progestin for 1 year, there may be 7 additional coronary heart disease events, 8 more strokes, 8 more pulmonary emboli, and 8 more invasive breast cancers 3
• The U.S. Preventive Services Task Force notes that recommendations against combined estrogen and progestin do not apply to women using hormone therapy for management of menopausal symptoms 4, 5

Practical Approach for Hormone Therapy Use

• The American Academy of Family Physicians recommends using the lowest effective dose of hormonal therapy for the shortest possible time to manage menopausal symptoms 6
• Consider individual risk factors for cardiovascular disease, thromboembolism, and breast cancer before prescribing hormone therapy 6
• For women with risk factors for thromboembolism, transdermal estrogen administration may be preferable 6