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Contraception and Sexually Transmitted Diseases During Perimenopause

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By: Wulf Utian MD PhD DSc

CONTRACEPTION

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:

1. THE BIRTH CONTROL PILL (ORAL CONTRACEPTIVE; OC) 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.

SEXUALLY TRANSMITTED DISEASES (STD)

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 subject.

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 summer.

Wulf Utian MD PhD DSc

Author; CHANGE YOUR MENOPAUSE – Why one size does not fit all. http://www.amazon.com/Change-Your-Menopause-size-does/dp/0982845723/

The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.

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