fUntil a few years ago, being over 35 was, in itself, a contraindication to the prescription of a pill. Yet a hormonal contraceptive in phase premenopausal can represent a optimal therapy both to prevent pregnancies, which in most cases would be unwanted given the advanced age, and to solve the problems of cycle irregularities that characterize this period.
Premenopausal pill, because it can help
48% of pregnancies in the 44-49 age group are not sought and only 2 to 15% of women who decide to get pregnant in this age group arrive at the end with a healthy baby in their arms and without consequences on own health.
When the reserve of ovarian follicles is running out, the pituitary (true regulatory center of the menstrual cycle) responds by trying to recruit the few remaining follicles. This leads to an increase in anovulatory cycles (without ovulation) with irregularities and abundant if not hemorrhagic flows, and the appearance of hormonal fluctuations that often cause annoying symptoms. Sometimes, the same menopausal symptoms such as hot flashes and insomnia make their appearance already a few years before the last period.
Oncological and cardiovascular risk
The marketing of new hormonal contraceptives with natural active ingredients, that is the same ones that the woman produces, and the possibility of an assumption route other than the oral one, has allowed to significantly reduce the risks related. Obviously, as with all therapies, the selection of the patient must be made accurately by the doctor in order to ensure that there are no pre-existing risk factors.
About security
There progestogen-only contraception (pill, coil or implant) does not increase thrombotic risk and demonstrated no increased risk of breast cancer. It allows you to solve the problem of abnormal bleeding and is an excellent contraceptive method, but by not providing estrogen supplementation, it fails to resolve the systemic symptoms related to the initial drop in this component and does not prevent bone resorption.
Using instead of a contraceptive that contains estrogen and progesterone allows to have and high efficacy in the prevention of pregnancyboth a good symptom control with a protective effect. However, the intake of these preparations is burdened by a small increase in risk, primarily that of venous thromboembolism, which is why it cannot be prescribed in women who already have pre-existing risk factors, such as smoking or being overweight or hereditary factors.
Less risk with the new pills
As for the cancer risk, the studies in our possession indicate a small increase in breast cancer in women using a hormonal contraceptive. But being all retrospective, they evaluated older generation pills that used different active ingredients and dosages versus more recently used ones. It is likely that this increased risk will not be confirmed with the new preparations.
The protective effect of the pill on some tumors
Few, on the other hand, know of the important protective effect of the pill on uterine and ovarian cancer, which lasts up to 20 years after intakehe was born in colon cancer.
In Italy there are still too few women who use hormonal contraception and there is still much resistance against it. There are few women who have real contraindications, which the doctor will have to evaluate and consider in selecting the most suitable therapy for each woman.
The same recognition by AIFA of the forthcoming free use of this class of drugs must represent a first step forward in the diffusion of a contraceptive and curative method that still sees us in the last places in Europe for the number of female users.
The sources
Tepper NK Journal of women’s health-2018
Linton A. Contraception for the perimenopausal women – Climatic 2019
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