CONTRACEPTION AT THE MENOPAUSE: BEFORE THE AGE OF FIFTY
Your periods must have stopped for at least twelve months for you to ignore contraception. If you are on the pill your periods will be pill-induced, and the pill must be stopped to confirm the absence of your periods for this length of time. Pill-induced periods have nothing to do with your own cycle. During this twelve months you should use barrier methods of contraception such as condoms and cream.
What are the alternatives if contraception is still necessary under the age of fifty? Just as in the selection of contraceptives at any age, you and your partner must work out with your doctor what best suits you, taking into consideration the general health factors of your age group. The physical condition of a woman with, for example, raised blood pressure and cardiac disease becomes more important, and if the woman also smokes, problems with these conditions also increase.
The combined pill using the lowest dose possible is a reasonable choice with regard to recent reports of the hazards of the pill to those over thirty-five. With these facts in mind, permanent methods of contraception, such as tubal ligation for women or vasectomy for men, are being suggested to more and more couples. Barrier methods using condoms or diaphragms combined with creams are coming back into fashion.
The intra-uterine device (IUD) has a place if the woman does not experience irregular bleeding. Although it has a 4 per cent failure rate, failure would declare itself by a missed period.
Termination could be sought, if desired, at an early stage.
The mucus method of contraception has a place for the well-trained couple, but again, irregular periods are a problem. In this case a woman who misses a period may suffer undue anxiety that she may be pregnant.
The progestogen-only pill does not usually produce regular periods, therefore pregnancy would not be so obvious so soon. It has a four per cent failure rate. Spotting, which is often associated with this pill, is also a problem with this age group of women as spotting may indicate other problems that should be investigated.
These are only a few basic points. Other considerations must obviously be taken into account, and these can only be assessed by you and your own doctor. One worry that women raise when hormones are used after menopause, and particularly when periods are reintroduced, is ‘Can this mean that I can get pregnant?’ The answer to this is no, provided periods have been absent for twelve months.
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