Contraceptive choices for women going through the menopause.

Contraception for women going through the menopauseThere are a lot of choices when it comes to contraception and you may have used different methods at different times in your life.

As you approach the menopause the chances of pregnancy reduces as your hormone levels change.  Your periods will become less frequent and less reliable.  This coincides with fewer eggs being released from the ovary.

Every woman’s menopause is different and it’s difficult to predict the age when yours will start.  If your mother started her menopause early then you may also.  Equally if she started hers late, you may have a later menopause, but this is not a rule.  Generally a woman’s fertility starts to decline after the age of 37.  Menopause for many women happens between the ages of 45 and 55 years.

Here we’re going to look at the birth control measures that are appropriate for you as you get towards the age of menopause.  Your choice will be influenced by:

  • Whether there are other medical problems you need to consider
  • Your lifestyle
  • How often you have sex
  • How effective a method is
  • Possible side effects.

The combined birth control pill is possibly the best know type of contraception and has been around since the 1960s.  It’s a combination of oestrogen (estrogen) and progesterone which prevent an egg from being released from the ovary and thicken the mucous in the cervix.

Advantages:

  • It’s easy to use – one pill every day, or every day with a 7 day break.
  • Evidence of some protection against ovarian and uterine cancer in women who take the pill.
  • Over 99% effective when taken correctly. It needs to be taken at the same time each day.

Disadvantages:

  • Its effectiveness will be compromised if forget to take it, vomit within 3 hours of taking it or have diarrhoea.
  • No protection against sexually transmitted infections (STIs)
  • Some people have weight gain or acne with the pill.

Good for you if:

  • You know you will remember to take it at the same time each day.
  • Have a regular routine.

Probably not for you if:

  • You’re over 35 and smoke (there are added health risks).
  • Have a personal or family history of clotting problems such as DVT or stroke.
  • Have high blood pressure.
  • Are overweight and have high blood pressure/are a smoker.
  • Don’t have a regular routine.
  • Are forgetful – you might want to think about the birth control patch or the contraceptive ring instead.

The Mini Pill is a progesterone only pill and may be more suitable for you if you can’t take the combined pill.

Its advantages and disadvantages are the similar to the combined pill but it’s even more important that it’s taken at the same time each day.

It can be taken by women who have health problems which mean they can’t take the combined pill – such as stroke or other blood clot problem.

Condoms sit over the man’s penis and prevent the sperm from getting into the vagina and therefore from reaching the egg.

Advantages:

  • Can be included in the fun of sex.
  • Easy to buy.
  • Ribbed condoms can enhance the woman’s pleasure.
  • 98% effective if used correctly
  • Can protect you or your partner against STIs and can be used with any other contraceptive method.
  • Women can carry them discretely.
  • There are alternative materials if you have a latex allergy.

Disadvantages:

  • Men often complain about loss of sensation with condoms.
  • They need to be used correctly; put on the erect penis before it has had any contact with the vagina or vaginal opening and removed from the vagina soon after your partner has climaxed.  Become familiar with the maker’s instructions.

Good for you if:

  • You are in a new relationship or have casual sex and are unsure about your partner’s sexual/STI history.
  • Feel confident asking a man to use a condom.
  • Feel you might be at risk of an STI.
  • Can’t/don’t want to use any other method of contraception.

The Intra Uterine Device (IUD) or copper coil is implanted into the womb and works by creating a ‘hostile’ environment for an egg to implant in the womb.

Advantages:

  • Lasts a long time – once it’s in it will work of up to 5 years.
  • Discrete – no one need know you have it.
  • No need to remember it so sex can be spontaneous.
  • More than 99% effective.

Disadvantages:

  • Can make your periods heavier.
  • Uncomfortable for the 5-10 minutes it takes to fit it.
  • Doesn’t protect you against STIs.
  • Greater risk of ectopic pregnancy (where the fertilised egg implants itself in the fallopian tube).

Good for you if:

  • Want a fit-and-forget contraceptive that will see you through the menopause.

Probably not good for you if:

  • Don’t like the thought of having it fitted.
  • Have a tendency to anaemia (anemia) because it makes your periods heavier.

The Intra Uterine System (IUS) is a coil, as above, but instead of being made of copper, it has a small rod of progesterone which is released slowly over 5 years.  This creates a set of circumstances in the body that prevent pregnancy.

The advantages and disadvantages are similar to the IUD but the IUS doesn’t make your periods heavier and in most cases stops them or makes them very light.  This means that it can be difficult to tell when your menopause has ended, unless you also have a lessening of other menopause symptoms.

The Cap or Diaphragm is made of latex or silicone andfits over the cervix creating a barrier that prevents the sperm from reaching the egg.  You put it in before sex and remove it at least 6 hours after.  Use it with a spermicide cream.

Advantages:

  • Easy to use once you’ve been shown.
  • May make having sex during your period easier as the cap holds back the menstrual flow.
  • No pills to take.
  • 92-96% effective if used correctly.

Disadvantages:

  • Sex needs to be more planned so that it’s in place when you need it.
  • No protection against STIs.
  • You need to be taught how to use it.
  • The spermicide cream can be a bit messy.

Good for you if:

  • Sex is planned.
  • You’re confident and comfortable putting it in and taking it out.

Probably not for you if:

  • You have an allergy to the spermicide – you will want to try another brand.
  • You like sex to be spontaneous and don’t want to have to ‘prepare’ for it.

Birth control injection is a high dose of progesterone given into the buttock muscle once every 8-12 weeks (depending on the brand) by a nurse or doctor.

Advantages:

  • Easy to use – have it and forget it for up to 3 months.
  • Can stop periods or make them very light.
  • It’s more than 99% effective.
  • Can be used while breastfeeding.

Disadvantages:

  • Can cause weight gain and acne.
  • You need to visit the nurse or doctor regularly to have the injection.
  • No protection against STIs.
  • Can cause thinning of the bones.

Good for you if:

  • Want a have-and-forget contraceptive.

Probably not for you if:

  • You have a personal or family history of osteoporosis (thinning of the bones) as this can get worse after the menopause.

Sterilisation is a permanent contraception choice.  The surgeon cuts and clips the fallopian tubes so that sperm cannot reach an egg.

Advantages:

  • You don’t have to think about it once it’s done.
  • Nearly 100% effective.

Disadvantages:

  • Needs a short stay in hospital and your abdomen may be a bit sore after the op.
  • Irreversible.
  • Doesn’t protect you against STIs.

Good for you if:

  • Your partner can’t/won’t have a vasectomy.

Probably not for you if:

  • You have health problems that mean you shouldn’t have anaesthesia.

The Contraceptive Implant is a small rod (about the size of a matchstick) of low dose progesterone.  It is implanted in to the underside of your upper arm and is effective for 3 years.

Advantages:

  • A fit-and-forget method.
  • Easily reversible – just have it removed.
  • More than 99% effective.
  • Periods stop in some women.

Disadvantages:

  • Can cause weight gain and oily skin but can be removed if you can’t tolerate it.
  • Needs to be fitted by a doctor trained in the procedure.
  • Periods can become irregular, as they do with the menopause.
  • No protection against STIs.

Good for you if:

  • You don’t want to have to think about contraception.
  • You don’t want to take a pill regularly.

Not for you if:

  • You haven’t got a trained doctor nearby who can fit it.

The Rhythm Method or Natural Family Planning means you work out which days it’s ‘safe’ to have sex and which days are more high risk – ie when it’s more likely that you’ll get pregnant.

Because this method relies on a regular menstrual cycle and the menopause makes the cycle more erratic and irregular, this method is much less reliable for women approaching and going through the menopause and isn’t recommended.

Abstinence is simply not having sex.  Whether to you, that means not engaging in any sexual activity beyond kissing, or petting but not having penetrative sex, it’s a reliable method of preventing pregnancy.

Disadvantages:

  • Needs discipline and an understanding partner.
  • If you are heavy petting you need to be 100% sure that the penis has no contact with the vagina.  A man’s pre-cum contains sperm as does the full come if this happens.
  • Can be frustrating for both partners.

For you if:

  • You have an understanding partner.
  • Are disciplined and determined.

 Can I still use emergency contraception in the menopause?

If you are worried because you have had sex without taking adequate birth control precautions or that your birth control may have failed, then you can take emergency contraception if your doctor or pharmacist is agreeable.

Is using HRT good for birth control?

The low hormone levels in hormone replacement therapy mean that it is not suitable for birth control.

If you are taking HRT then you can also take the progesterone only pill (the mini pill) or have an IUCD or IUCS fitted.  See the articles in this series for more details on these methods of birth control.

How long will I have to use birth control?

If you’re using a method such as:

  • the progesterone only pill,
  • the combined pill,
  • the patch or ring,
  • the copper coil
  • cap or diaphragm
  • or condoms,

then you should be able to stop using birth control 1 year after your periods stop, if you’re aged over 50 years.

If you’re aged under 50 years you can stop using birth control 2 years after your periods stop.

If you’re using methods such as:

  • the hormone coil (IUCS),
  • implant
  • or injection,

which stop your periods or make them lighter and less regular, then it’s more difficult to know if you would still be fertile if you stopped using it.

In this case you should talk to your health care provider about when you should stop using birth control.  In most cases these methods can be used until age 55, unless there are other medical problems that mean you should not use them.

After age 55 you shouldn’t need birth control, but may want to use condoms until you know you are not going to have a period (which would indicate eggs are still being produced from the ovaries).

For information about fertility during the menopause, see this article from Everyday Health.

Share
This entry was posted in Contraception choices, Menopause health and help. Bookmark the permalink.