Contraception around menopause

ALTHOUGH pregnancy is less likely around the time of the menopause, it is still necessary to use contraception until you have gone through the menopause or are aged 55 years if you do not wish to become pregnant.

As mentioned in last week’s article, periods become irregular and unpredictable before stopping entirely around the time of the menopause. Although one is less likely to ovulate every month, ovaries will still continue to produce eggs. So, although there is a natural decline in fertility after the age of 37 years, effective contraception is essential for all women who do not wish to become pregnant.

SHORT ACTING CONTRACEPTIVES

* Combined pill

The combined pill - or ' the pill' - is more than 99% effective when used correctly. Containing oestrogen and progesterone, the pill can safely be taken by women over the age of 40 years who do not suffer from any medical problems. However, it should not be taken by women over 35 years who smoke and the pill should be replaced with another form of contraception when the age of 50 years is reached.

* Progesterone only pill

This ' mini pill' contains progesterone alone. It is also more than 99% effective when used correctly and is commonly used by women who cannot take the ordinary pill i. e. women who smoke, suffer with migraine or cardiovascular disease. The mini pill can be used until the age of 55 years after which time contraception will no longer be required.

* Contraceptive patch

This is the same as the combined pill but in patch form and is available to the same group of women who can use the combined pill. The patch is applied to the skin so that oestrogen and progesterone are continuously delivered to the body.

* Barrier methods

These include condoms, the female condom, diaphragms and caps. Although generally less reliable, they hold no serious medical risks or have any side effects.

LONG ACTING CONTRACEPTIVES

* Contraceptive injection

This injection, which lasts for 8- 12 weeks, contains progesterone which is slowly released into the body. It is more than 99% effective and works similarly to the mini pill. There may be a reduction in bone density with long term use and it is not recommended beyond the age of 50 years.

* Contraceptive implant

This small progesterone device placed under the skin, usually on the inner surface of

“Ovaries will still continue to produce eggs”

It is necessary to use contraception until you have gone through the menopause or are aged 55 years

the arm, is more than 99% effective and lasts for three years. It can be used until the age of 55 years, after which time contraception will no longer be required. Like the mini pill it may be used by women who smoke, suffer with migraine or cardiovascular disease.

* Intrauterine contraceptive system

This is a plastic device that contains progesterone, which lasts for five years and is more than 99% effective. It works similarly to the mini pill and so it is safe in smokers, migraine sufferers or those with cardiovascular disease. It can be used until the age of 55 years, after which time there is no need for contraceptive protection.

* Sterilisation

This is a permanent method of contraception which requires a general anaesthetic.

HRT AND CONTRACEPTION

As HRT uses very low levels of hormones, it does not work as contraception. Unless you have gone through the menopause before you started HRT, contraceptive cover will be necessary until the age of 55 years. The mini pill or intrauterine system may be used with HRT.