Stopping contraception after menopause
At what age can contraception (either oral contraceptives or medroxyprogesterone [Depo-Provera]) be safely discontinued in a postmenopausal patient? Also, is there any value in testing hormones (follicle-stimulating hormone [FSH], luteinizing hormone [LH], estrogen) in a woman on hormonal contraception? Would the values be skewed by the prescribed medication?—PAMELA J. WEAKLAND, PA-C, California, Pa.
Oral estrogen-containing medications are effective in reducing the vasomotor symptoms of menopause (e.g., hot flushes). In addition, estrogen combats the re-absorption of bone and stimulates release of calcitonin, which helps reduce risk for osteoporosis. There is also evidence that estrogen-containing medications help reduce the irritability and insomnia that often occur during the perimenopausal period. Estrogens may help relieve symptoms of fibroids and reduce the risk of endometrial and ovarian cancer. Data are not definitive, however, and more research is needed. Combination contraceptives suppress hormone levels, thereby inhibiting ovulation. Once a woman is postmenopausal, ovulation stops. While on combination contraceptive therapy, the FSH and LH levels will be suppressed. After the medications are stopped, FSH and LH levels may remain suppressed. If menopausal symptoms are bothersome or the risk of osteoporosis is great, the patient can be transitioned to HRT. Use the lowest dose for the shortest duration to reduce the other risks attributed to HRT (e.g., breast cancer, stroke, MI, and blood clots).—Claire Babcock O'Connell, MPH, PA-C (134-5)