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ARTICLE IN PRESSG ModelAT-6116; No. of Pages 1
Maturitas xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Maturitas
jo u r n al hom ep age: www.elsev ier .com/ locate /matur i tas
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etter to the Editor
on-contraceptive benefits of hormonal contra-eptive use during perimenopause?
ear Editor,
We enthusiastically read Baldwin and Jensen’s review of contra-eptive use during perimenopause [1]. In the section dedicated toormonal contraceptives (HCs), the authors meticulously describehe indications for HC use, the potential risks, and when/how toiscontinue use. However, we feel that this review lacks a sec-ion dedicated to the potential non-contraceptive benefits of HCse among perimenopausal women. While there is strong evidencehowing that HC use is associated with reductions in menstrualleeding, menstrual cramping, and gynaecological cancers in youngomen, data among perimenopausal women are lacking. Indeed,
he large majority of studies evaluating these benefits have beenonducted on women younger than 40, commonly those less than5.
HCs have been successfully used to treat menstrual disordersn women of all ages. Some guidelines have even suggested thathe use of HCs in healthy women over 40 without menstrual dis-rders may reduce gynaecological cancers, bone mass loss, andardiovascular disease (CD). Although there is little controversyegarding the use of HCs among perimenopausal women due to thebove-mentioned benefits, we also know that some gynaecologicalancers increase with age and menstrual irregularity and that theseonditions are reduced with HC use. Perimenopause is a period ofncreased bone remodelling, and we know that HCs can maintainone mass density. However, the effect of HCs on CD requires fur-her study, as strategies once thought to reduce disease risk werehown to increase this risk if the hormone type, dose, or timingere not appropriate; specifically, this was the lesson learned fromormone therapy (HT).[2]
Recently, the importance of ovarian function cessation inepression and CD risk was assessed, and a bi-directional relation-hip between these two conditions seems to exist, with both ofhese conditions also associated with the possibility of menstrual
Please cite this article in press as: Mendoza N, Sánchez-Borrego R. Nperimenopause? Maturitas (2014), http://dx.doi.org/10.1016/j.maturi
ycle alteration. Various neuroendocrine mechanisms are involvedn this process, although the link that unites these conditionss the ovarian dysfunction. From this perspective, women in the
enopausal transition period experience greater mood changes,
ttp://dx.doi.org/10.1016/j.maturitas.2014.02.003378-5122/© 2014 Elsevier Ireland Ltd. All rights reserved.
even more than during the subsequent period, which is when theCD risk increases [3].
Similar to what was proposed for hormone treatment, wherea “window of opportunity” exists in which the benefits of HT(fundamentally cardiovascular) outweigh the risks, a “windowof vulnerability” for CD and depression during perimenopausecould exist [4]. Could HC mitigate these risks and be consid-ered a protective factor during this window of vulnerability?Indeed, current studies have recently begun to publish positiveresults in postmenopausal women (ELITE, KEEPS, etc.). How-ever, further studies are required to investigate these – andother possible beneficial effects – of HCs in perimenopausalwomen.
References
1] Baldwin MK, Jensen JT. Contraception during the perimenopause. Maturitas2013;76:235–42.
2] de Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement onmenopausal hormone therapy. Maturitas 2013;74:391–2.
3] Bleil ME, Bromberger JT, Latham MD, et al. Disruptions in ovarian functionare related to depression and cardiometabolic risk during premenopause.Menopause 2013;20:631–9.
4] Mendoza N, Sanchez-Borrego R, Cancelo MJ, et al. Position of the SpanishMenopause Society regarding the management of perimenopause. Maturitas2013;74:283–90.
Nicolás Mendoza ∗
Department of Obstetrics and Gynecology, Universityof Granada, Granada, Spain
Rafael Sánchez-BorregoClínica Diatros, Barcelona, Spain
∗ Corresponding author at: Maestro Montero, 21,18004 Granada, Spain. Tel.: +34 958120206; fax:
+34 958120206.E-mail addresses: [email protected] (N.
Mendoza), [email protected] (R.
on-contraceptive benefits of hormonal contraceptive use duringtas.2014.02.003
Sánchez-Borrego)
7 February 2014Available online xxx
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