More and more women are getting pregnant in the perimenopausal period. Some are planned but the clear majority are unplanned pregnancies that often have many unfortunate consequences.
What are perimenopausal years?
The perimenopausal years are the years around the menopause. The menopause is the permanent cessation of menstruation caused by the loss of ovarian follicular activity. The diagnosis of menopause is often made after one year of a woman not seeing her menstrual periods. The period immediately before menopause is called perimenopause. During the perimenopausal period, a woman might experience a variety of symptoms to include the following:
• Hot flushes/flashes
• Menstrual irregularities to include heavy menstrual bleeding
• Lower sex drive
• Fatigue
• Vaginal dryness/discomfort during sex
• Painful breast
When to stop using contraception
This is often a tricky question for many couples and their healthcare providers.
For women over the age of 50 years who do not use hormonal methods, contraception can be stopped after one year of amenorrhoea (menstrual periods) as fertility is unlikely to return. In women under the age of 50, contraception should be continued for two years as the return of fertile ovulation is more likely to occur.
Hormonal contraception can affect bleeding patterns making it difficult for gynaecologists to advise when contraception can safely be stopped.
Women can consider stopping their method of contraception at the age of 55 years when most will have reached natural infertility.
Methods of contraception during the perimenopausal years
Healthcare providers should advise women of all the available methods of contraceptives so that they can make an informed choice. Up to the age of 50, age alone should not be used to prevent contraception use, but it is important to determine if any other medical conditions the woman might have – as well as risk factors such as smoking – before a woman uses contraception. All women should have a detailed personal, sexual and family history taken prior to the use of any contraception. Clinical examination including blood pressure and weight measurement is very important, as well as well as recent cervical smears.
In Anguilla, many types of contraception are available for women during their perimenopausal years. They include:
• Intrauterine devices
• Intrauterine systems
• Injectable contraception
• Progestogen – only pills
• Barrier methods – male and female condoms
• Natural family planning methods
• Sterilisation
Combined hormonal contraception
The use of combined hormonal contraception, more commonly called the Pill, is not recommended for use beyond the age of 50 years. For smokers, some gynaecologists would not recommend the combined hormonal contraception after the age of 35 years. Women with a history of veno-pulmonary embolism should avoid the combined hormonal contraception.
Counselling
All women receiving contraception should be counselled, but it is of greater importance for women in the perimenopausal years. There are some side effects associated with various methods which will vary depending on the individual client. In several countries many women in the perimenopausal period are developing sexually transmitted infections, and at present time only the barrier methods of contraceptions can help reduce this risk.
Conclusion
Some women mistakenly believe that they cannot become pregnant after the age of 45 years. This is far from the truth. Once a woman is ovulating she can become pregnant. It is important that women use a reliable and safe method of contraception, during the perimenopausal years, if they want to avoid an unplanned pregnancy. Talk to your gynaecologist or healthcare provider, today, about the various methods of contraception available in Anguilla – or talk to any member of the Anguilla Family Planning Association.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field are ongoing, it is possible that new findings may supersede some data presented.
Dr Brett Hodge MB BS DGO MRCOG, is an Obstetrician/Gynaecologist and Family Doctor who has over thirty-two years in clinical practice. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
