CONTRACEPTION AFTER FORTY

In the current world culture, there are many of us who are desperate to have a baby at a perimenopausal age. So far they have been studying and trying to make a career and suddenly they realize that the time is running out to have a baby as the biological clock is closing down. On the other hand many of us want to know how to stop having a baby as this will become a serious handicap with everything else happening. Perimenopause is a difficult time for women, as they have many peri menopausal symptoms such as irregular heavy menstrual cycles, hot flushes, tiredness and other menopausal symptoms. It is hard to keep a track of pregnancy risk time. This also called CLIMACTERIC can last up to 6-7 years. It is difficult to use natural methods of contraception as the menstrual cycles become irregular .Age does not preclude any contraceptive methods The choice depends on your , medical history(heavy periods fibroids and endometriosis)your weight, life style for e.g, if  you are a smoker or not .How active is your sex life. In a normal healthy woman, non-smoker, no blood pressure, no history of stroke, DVT personally or in the family, oral contraceptive pill is safe, it can be better if it has lower oestrogen levels. It also helps with your menopausal symptoms such as hot flashes night sweats, dry vagina , painful sex. If you are post menopaual and you are under 50, stop your pill  2 years after your last menstrual period, if you are over 50 then stop after one year of your last menstrual period. If you are taking O.C pill, your periods are generally bleeding following the use of the pill. If you do not know if you are menopausal to establish this, stop the pill for 2 months and test the Follicular stimulating hormone twice. During this time use condoms or abstain. If it comes high then you are post menopausal and do not need contraception. It is extremely rare to have a pregnancy after menopause, not that it never happens. I have delivered three post menopausal women in my career. Luckily the baby’s were normal and with uncomplicated pregnancies .The combined oral contraceptive pill (COC) is also very useful if a woman has heavy, painful and irregular periods. If they skip the sugar tablets, have a period ever 2-3 months, this may even prevent premenstrual tension (PMT).It decreases the risk of functional ovarian cysts, endometrial cancer. It has been shown in some studies that if a woman has been taking COC for more than 12 months she is protected from the risk of pelvic infections to some extent, this is being studied further. The other worry about oral contractive is about the risk of breast cancer, if a woman uses a pill less than20 micrograms of oestrogens, she has no family history of breast cancer, she personally has not had abnormal cells on aspiration, and she does not have abnormal genes for breast cancer, it is was not linked to higher risk of breast cancer. Women  who smoke, have high blood pressure have a BMI of more than 30, have diabetes, history of cardiovascular disease, personally or in the family,  increased waist circumference(limited clinical information on this). Combined vaginal ring is another alternative. It is inserted in the vagina for 3 weeks and removed for one week; some women prefer it, as it is used once a month rather than daily. It has slightly less oestrogen. It will have the same side effects as the COC, breast tenderness headaches (migraine), increased risk of breast cancer. The risk of DVT may be less. It works in the same away as the COC. In some women it can be expelled due to pelvic floor weakness. The clinical research evidence on this is limited.

Progesterone only contraceptives are often used, such as minipill (progesterone only pill), depomedroxyprogesterone acetate (DMPA) injection, progesterone implant (ETONODRYL). These do not benefit from the effects of menopausal symptoms, in addition cause irregular spotting and bleeding, which is already an existing problem in this age group. This is not good for bone health, as these cause amenorrhea, and a year of amenorrhea causes bone loss of 1%. The operation such as tubal ligation by key whole surgery is often performed. This is an operation and inherited risks of operations are all there. All these methods have a failure rate of 1%. Simple method such as condoms, male or female, withdrawal and a diaphragm   are also used. Diaphragm has to be fitted by a clinician and needs changing. If you loose or gain more than 5 kilograms. It is also not suitable if a woman has latex or spermicidal allergy. It is also not suitable for women with pelvic floor weakness. Intrauterine contraceptives are good for this group. There are copper, and hormonal IUCD’s, originally we had some plastic IUCD’s. The copper IUCD is fitted inside the uterus, it can remain there for 5-10 years these sometimes tend to cause heavy, painful periods. The most popular IUCD is hormonal called Mirena. It contains a hormone called levonogestral which is slowly released over 5 years. It is fitted by a clinician inside the uterine cavity initially for 2-3months. It can cause some irregular bleeding for the initial 2-3months they usually have amenorrhea it is effective for 5 years. It is useful for taking oestrogens with it for HRT. It can be left for another year or two for contraception, but if a woman is taking oestrogens as well, it needs to be changed after 5 years. These are not suitable for women who run the risk of STI’s. All women using these contraceptives need to protect themselves from STI’s. There is also emergency contraception with in 5 days of unprotected sex a copper IUCD fitted in, can work and loose the developing foetus or women can use the morning after pill.

For further information on Contraception/IUD’s please refer to my previous post Dated April 25th 2015.