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The inability to conceive after menopause is
considered to be a major benefit to most women. But remember that the final
menstrual period, the menopause, is only diagnosed after periods have been
missed for 12 months. Indeed the cycle in the perimenopausal years can be quite
irregular. With that comes the risk of pregnancy. I have actually had several
patients over the years come into the office looking for help with menopause,
only to find that they were pregnant, sometimes quite advanced.

This means that women who do not want to conceive,
despite their proximity to menopause, need contraception. Fertility rates
decrease with age, that is it becomes less likely that pregnancy will occur as
one gets older. In turn, types of contraception that were less effective in
younger women can be quite effective closer to menopause. A diaphragm for
example is more effective in later reproductive years, as are spermicidal
creams and gels. The following are satisfactory forms of contraception after
age 35:

in its latest versions is relatively safe. The lowest dose forms are
recommended. Moreover, the so-called progestin-only pill becomes a real option.

Nevertheless, there are some precautions or reasons
not to take one of these pills. Firstly, smokers should avoid the OCs.
Secondly, a number of medical conditions are also contraindications. These
include a history of heart disease, liver cancer or liver problems, breast
cancer, diabetes, hypertension, and large uterine fibroids.

On the brighter side, there are a number of
potential benefits that come with the use of the OC. These include apparently
reduced incidences of uterine and ovarian cancer, pelvic inflammatory disease,
anemia, and rheumatoid arthritis. Further benefits may include a reduced risk
of fibrocystic and other benign breast diseases, improved regulation of the
menstrual cycle and periods, relief of symptoms of PMS, and there is no
increased risk of breast cancer.

2. CHEMICAL AND BARRIER METHODS such as the condom,
diaphragm, and chemical spermicides are really good options. They are not fool
proof, but very close to that as menopause approaches. Condoms were
occasionally problematic for older men, but this is less of a problem with the
increased use of erectile dysfunction medications.

3. THE INTRAUTERINE DEVICE (IUD) is an exceptionally
good method for older women who have completed childbearing. It is unobtrusive,
very effective, carries few side effects, and is relatively inexpensive given
its length of use. Removal is quite easy. One particular benefit will come with
new small devices that contain the progestogenic hormones and will be used to
protect the endometrium of women taking ET.

4. STERILIZATION is the last resort because it
involves a small surgical procedure and is for the most part permanent. Yet it
actually is the most frequently chosen method of contraception by women over
35. There are a variety of new techniques available and the  procedures are generally short and
rarely complicated.


Just because women are older does not mean they
cannot be at risk for a sexually communicated disease. The major STDs include
herpes and AIDS. Without going into the detail of the STDs, prevention is the
name of the game. That is, practicing safer sex is the key element to
prevention, whether it is against a nuisance problem like herpes, or a
potentially lethal condition like AIDS.

Peri- and postmenopausal women have an extremely
low incidence of AIDS. Those in a monogamous relationship with no outside
contacts have no cause for concern. But if uncertain, or about to enter a new
relationship, the small possibility of transmission always exists, and
preventive safer sex practice is imperative. For a new relationship, one way of
being certain about AIDS is for both partners to take an AIDS screening test.
Without AIDS testing, safer sex means using condoms during vaginal and oral
sex. Open and honest discussion is essential. AIDS is no longer an unspoken

That’s it for this
week. Sorry to end on a note of STD’s but I will be back early in September
with a column on the good news that can be summarized from all my previous
blogs – menopause of itself is associated with remarkably few true symptoms!

Enjoy the rest of

Utian MD PhD DSc

MENOPAUSE – Why one size does not fit


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