From oral contraception to hormone replacement therapy: towards a continuum?
L'Hermite, M.; Van Pachterbeke, C.; Van Roosendaal, E.
Maturitas Suppl 1: 155-165
1988
ISSN/ISBN: 0378-5122 PMID: 3237108 DOI: 10.1016/0378-5122(88)90017-5Document Number: 362988
On the basis of available evidence, it is reasonable to conclude that at this time women between 35-45 years should not be denied the benefit of oral contraception (OC) if they do not smoke. As Upton recently reported, the risk of death due to pregnancy and childbirth, even in a developed country such as the US, is greater than the risk of OC, including the risk for OC users who smoke. Low-dose, or very low-dose, ethinyl-estradiol combined OCs most likely can be prescribed safely for most women up to the time of menopause in the absence of cardiovascular risk factors. The alternative treatments that might be initiated before and then continued during and after the climacteric include: cyclic or continuous combined estrogen-progestogen preparations containing estradiol (in valerate or micronized form); "transdermal therapeutic systems" delivering both estrogen and progestogen, for cyclic or even continuous use; and other newly-developed means of delivering fairly constant doses of steroids, such as pellet implants and microspheres. The combination of estradiol pellet implants with the cyclic or continuous administration of progesterone or a progestogen also might prove to be a promising approach if estrogen accumulation could be avoided. Substantial effort still needs to be made to improve the available preparations and provide the clinician and the women concerned with the best possible formulations for use in the perimenopause, and possibly indefinitely afterwards as true substitution therapy.