- Email: [email protected]
Non-contraceptive benefits of hormonal contraceptive use during perimenopause?
G Model MAT-6116; No. of Pages 1
ARTICLE IN PRESS Maturitas xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Letter to the Editor Non-contraceptive benefits of hormonal contraceptive use during perimenopause? Dear Editor, We enthusiastically read Baldwin and Jensen’s review of contraceptive use during perimenopause [1]. In the section dedicated to hormonal contraceptives (HCs), the authors meticulously describe the indications for HC use, the potential risks, and when/how to discontinue use. However, we feel that this review lacks a section dedicated to the potential non-contraceptive benefits of HC use among perimenopausal women. While there is strong evidence showing that HC use is associated with reductions in menstrual bleeding, menstrual cramping, and gynaecological cancers in young women, data among perimenopausal women are lacking. Indeed, the large majority of studies evaluating these benefits have been conducted on women younger than 40, commonly those less than 35. HCs have been successfully used to treat menstrual disorders in women of all ages. Some guidelines have even suggested that the use of HCs in healthy women over 40 without menstrual disorders may reduce gynaecological cancers, bone mass loss, and cardiovascular disease (CD). Although there is little controversy regarding the use of HCs among perimenopausal women due to the above-mentioned benefits, we also know that some gynaecological cancers increase with age and menstrual irregularity and that these conditions are reduced with HC use. Perimenopause is a period of increased bone remodelling, and we know that HCs can maintain bone mass density. However, the effect of HCs on CD requires further study, as strategies once thought to reduce disease risk were shown to increase this risk if the hormone type, dose, or timing were not appropriate; specifically, this was the lesson learned from hormone therapy (HT).[2] Recently, the importance of ovarian function cessation in depression and CD risk was assessed, and a bi-directional relationship between these two conditions seems to exist, with both of these conditions also associated with the possibility of menstrual cycle alteration. Various neuroendocrine mechanisms are involved in this process, although the link that unites these conditions is the ovarian dysfunction. From this perspective, women in the menopausal transition period experience greater mood changes,
even more than during the subsequent period, which is when the CD risk increases [3]. Similar to what was proposed for hormone treatment, where a “window of opportunity” exists in which the benefits of HT (fundamentally cardiovascular) outweigh the risks, a “window of vulnerability” for CD and depression during perimenopause could exist [4]. Could HC mitigate these risks and be considered a protective factor during this window of vulnerability? Indeed, current studies have recently begun to publish positive results in postmenopausal women (ELITE, KEEPS, etc.). However, further studies are required to investigate these – and other possible beneficial effects – of HCs in perimenopausal women. References [1] Baldwin MK, Jensen JT. Contraception during the perimenopause. Maturitas 2013;76:235–42. [2] de Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Maturitas 2013;74:391–2. [3] Bleil ME, Bromberger JT, Latham MD, et al. Disruptions in ovarian function are 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 Spanish Menopause Society regarding the management of perimenopause. Maturitas 2013;74:283–90.
Nicolás Mendoza ∗ Department of Obstetrics and Gynecology, University of Granada, Granada, Spain Rafael Sánchez-Borrego Clínica 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. Sánchez-Borrego) 7 February 2014 Available online xxx
http://dx.doi.org/10.1016/j.maturitas.2014.02.003 0378-5122/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Mendoza N, Sánchez-Borrego R. Non-contraceptive benefits of hormonal contraceptive use during perimenopause? Maturitas (2014), http://dx.doi.org/10.1016/j.maturitas.2014.02.003
ARTICLE IN PRESS Maturitas xxx (2014) xxx–xxx
Contents lists available at ScienceDirect
Maturitas journal homepage: www.elsevier.com/locate/maturitas
Letter to the Editor Non-contraceptive benefits of hormonal contraceptive use during perimenopause? Dear Editor, We enthusiastically read Baldwin and Jensen’s review of contraceptive use during perimenopause [1]. In the section dedicated to hormonal contraceptives (HCs), the authors meticulously describe the indications for HC use, the potential risks, and when/how to discontinue use. However, we feel that this review lacks a section dedicated to the potential non-contraceptive benefits of HC use among perimenopausal women. While there is strong evidence showing that HC use is associated with reductions in menstrual bleeding, menstrual cramping, and gynaecological cancers in young women, data among perimenopausal women are lacking. Indeed, the large majority of studies evaluating these benefits have been conducted on women younger than 40, commonly those less than 35. HCs have been successfully used to treat menstrual disorders in women of all ages. Some guidelines have even suggested that the use of HCs in healthy women over 40 without menstrual disorders may reduce gynaecological cancers, bone mass loss, and cardiovascular disease (CD). Although there is little controversy regarding the use of HCs among perimenopausal women due to the above-mentioned benefits, we also know that some gynaecological cancers increase with age and menstrual irregularity and that these conditions are reduced with HC use. Perimenopause is a period of increased bone remodelling, and we know that HCs can maintain bone mass density. However, the effect of HCs on CD requires further study, as strategies once thought to reduce disease risk were shown to increase this risk if the hormone type, dose, or timing were not appropriate; specifically, this was the lesson learned from hormone therapy (HT).[2] Recently, the importance of ovarian function cessation in depression and CD risk was assessed, and a bi-directional relationship between these two conditions seems to exist, with both of these conditions also associated with the possibility of menstrual cycle alteration. Various neuroendocrine mechanisms are involved in this process, although the link that unites these conditions is the ovarian dysfunction. From this perspective, women in the menopausal transition period experience greater mood changes,
even more than during the subsequent period, which is when the CD risk increases [3]. Similar to what was proposed for hormone treatment, where a “window of opportunity” exists in which the benefits of HT (fundamentally cardiovascular) outweigh the risks, a “window of vulnerability” for CD and depression during perimenopause could exist [4]. Could HC mitigate these risks and be considered a protective factor during this window of vulnerability? Indeed, current studies have recently begun to publish positive results in postmenopausal women (ELITE, KEEPS, etc.). However, further studies are required to investigate these – and other possible beneficial effects – of HCs in perimenopausal women. References [1] Baldwin MK, Jensen JT. Contraception during the perimenopause. Maturitas 2013;76:235–42. [2] de Villiers TJ, Gass ML, Haines CJ, et al. Global consensus statement on menopausal hormone therapy. Maturitas 2013;74:391–2. [3] Bleil ME, Bromberger JT, Latham MD, et al. Disruptions in ovarian function are 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 Spanish Menopause Society regarding the management of perimenopause. Maturitas 2013;74:283–90.
Nicolás Mendoza ∗ Department of Obstetrics and Gynecology, University of Granada, Granada, Spain Rafael Sánchez-Borrego Clínica 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. Sánchez-Borrego) 7 February 2014 Available online xxx
http://dx.doi.org/10.1016/j.maturitas.2014.02.003 0378-5122/© 2014 Elsevier Ireland Ltd. All rights reserved.
Please cite this article in press as: Mendoza N, Sánchez-Borrego R. Non-contraceptive benefits of hormonal contraceptive use during perimenopause? Maturitas (2014), http://dx.doi.org/10.1016/j.maturitas.2014.02.003