Surely I don’t still need contraception…
If you are in your 40s or 50s and approaching the age of menopause (which happens on average at the age of 51), you may be feeling happy that you don’t have to think about contraception any more. Well think again … although fertility does naturally decline after the age of 35, some women do still ovulate into their 50s, and pregnancies can be naturally conceived at this age. The chance is small, but not non-existent. The current recommendation from Family Planning organisations is that women under the age of 50 should still use contraception for 2 years after their last period, and for women over the age of 50, contraception should be used for 1 year after the last period. If you are already using a hormonal method of contraception which is affecting your natural bleeding pattern, talk to your doctor about other ways of determining whether you still need to use contraception or not.
Menopause Pregnancy Risk & Contraception …
A useful method of contraception around the time of menopause is the levonorgestrel –releasing intrauterine device (Mirena®). This device sits inside the uterus and releases a low dose of a progestogen (levonorgestrel). It is one of the most effective methods of contraception available, being more than 99% effective at preventing pregnancy. Once it is in place, it stays there for 5 years, with no need to take a daily pill or remember to use a condom each time you have sex. Most women do not experience any significant side effects to such a low dose of hormones, and often it has the benefit of causing lighter periods (or even no periods at all), because it thins the endometrium (lining of the womb) so there is nothing to shed each month. The great advantage of the Mirena® in the perimenopause is the fact it can be used as the progesterone component of MHT (menopausal hormone treatment – the new name for HRT), if you are prescribed this by your doctor for relief of menopausal symptoms. At our clinic we are able to offer you insertion of intrauterine devices, either awake or with sedation.
Condoms and diaphragms can also be popular methods of contraception in the perimenopause. They do have higher failure rates than other methods of contraception, but due to the lower baseline fertility in most women of this age, they can be quite acceptable to use. Unfortunately diaphragms are no longer being manufactured in Australia, but there is a new ‘one size fits most’ diaphragm called Caya®, which is now available and can be ordered online. It is recommended that you attend a doctor to check that Caya® is right for you and that you are using it correctly.
So don’t chuck out that Pill packet just yet…come and talk to our doctors about your options for contraception.
By Dr. Julia Menzies