AS LONG AS a woman has a menstrual period, there is the possibility of pregnancy although the chances are increasingly remote as one approaches the menopause. Even if a woman has perimenopausal symptoms, it does not mean that she cannot get pregnant. About 75% of pregnancies in women above the age of 40 years are unplanned.
A woman is considered to have reached the menopause if she has not had a period for 12 consecutive months. This is a retrospective diagnosis. The average age of the menopause is 50-51 years. It is generally thought that contraception should be continued for two years after the last menstrual period in women under 50 years of age and for a year after the last menstrual period in women more than 50 years of age.
Hormone replacement therapy (HRT) does not provide contraception as it does not suppress ovulation. Many women commence HRT before they reach the menopause. It is difficult to know when the menopause occurs and how long contraception is needed. Stopping the HRT medication for six to eight weeks and then checking the blood hormone levels can confirm the menopause.
Some women use a fertility awareness method by abstaining from sexual intercourse at certain times in the menstrual cycle. This method cannot be depended upon if the menstrual cycle is the least bit irregular; irregular cycles are common during the perimenopause.
There are various birth control options (contraception) available. The doctor can help a couple choose an appropriate method depending on the medical history, sexual habits, lifestyle and preferences. The methods are described below:
The Pill is not prescribed in pregnancy, suspected pregnancy, cigarette smokers above the age of 35 years, or those with a history of uncontrolled high blood pressure, blood clots, coronary artery disease or breast cancer.
The benefits of the Pill include a reduced risk of endometrial and breast cancer, less fibrocystic disease of the breast changes, regulation of periods and reduced postmenopausal bone loss. There is a very slight increase in the relative risk of breast cancer in all current users of COC. As the incidence of breast cancer increases with age, this may become more significant in those above 40 years of age.
The side effects are few and may include nausea, bleeding between periods, breast tenderness, fluid retention and new or worsening headaches.
An IUCD cannot be inserted in pregnancy, suspected pregnancy, those who have a history of pelvic inflammatory disease, sexually transmitted infections, anaemia or abnormal vaginal bleeding, or those in a polygamous relationship.
The side effects may include spotting, irregular, prolonged or heavier periods or uterine cramps. These usually occur soon after insertion, which may be uncomfortable.
It is not prescribed in pregnancy, vaginal bleeding of undetermined origin, liver disease, blood clotting conditions and breast cancer.
The side effects may include menstrual cycle changes and weight gain. Regular visits to the doctor’s clinic for the injections are required.
The condom is the only effective method that prevents pregnancy and protects against sexually transmitted infections. Condoms can be used in combination with other birth control methods. The condom may leak, spill when being removed or even break.
It is not prescribed in pregnancy, undetermined vaginal bleeding, liver disease, breast cancer or blood clots.
The side effects may include nausea, weight change, acne, vaginal dryness, irregular uterine bleeding and headaches, especially in the first year after insertion.
An IUCD can be inserted within 120 hours. They should not be used as regular birth control methods.
There is no perfect contraceptive method. All methods have a failure rate.
However, the methods with no user failure are progestogen injections and implants, intra-uterine contraceptive device and sterilisation.
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