Many women assume that past the age of 40, they are too old to get pregnant. Some will be surprised! Fortunately, pregnancy is medically safe for a healthy woman, even at that age. However, many women over age 40 have medical problems that can make a pregnancy unsafe. Further, women over age 40 are likelier to miscarry or have a baby with a genetic defect. Finally, a lot of women simply don't want to be dealing with diapers and menopause at the same time! Continue to be careful; don't get complacent about contraception.
Many contraceptives are available. None is perfect, but a woman who doesn't want a surprise pregnancy needs to be sure that she or her partner uses some method of birth control until a year past menopause. That is, a year after her last natural period if it occurs in her early 50s; women whose periods stopped in their 40s need to have blood tests done to be sure they are indeed going through menopause. More than one woman has sought medical attention for "menopause" because of missed periods, weight gain, and fatigue only to discover her "menopause" had arms, legs, and a heartbeat!
Birth control methods that are appropriate for midlife women include:
Condoms: They are safe and offer good protection against many sexually transmitted diseases. They fail in three to eight percent of couples. They are a particularly good choice for single women who may have occasional encounters with new partners. The new "female" condom is a bit cumbersome but offers even better disease protection. If you are just beginning a new sexual relationship, remember the rules of "safe sex." With sexually transmitted diseases and AIDS rampant among both the heterosexual and homosexual populations, barring abstinence, condoms are the best way to protect yourself and your new partner.
Foams, sponges, and spermicides: These are chemical methods that use a substance that inactivates sperm. Although they have fairly high failure rates in young women, they can be an excellent choice for women in their late 40s. They offer some protection against diseases and vaginal infections, although some women will find them irritating, and allergic reactions can occur.
Diaphragms and cervical caps: These small cup-shaped rubber devices cover the cervix to prevent pregnancy and are a good method of birth control for couples who do not prefer to use condoms. However, they do not protect against sexually transmitted diseases. Diaphragms and cervical caps require fitting with a physician and instructions. Cervical caps are not widely available in the United States.
IUDs: Intrauterine devices are small plastic inserts that go into the uterine cavity. Women with a history of internal pelvic infections or with multiple partners should avoid them, but they can be excellent for monogamous women. Failure rates are one to two percent. A copper-containing IUD, ParaGard, can be used for 12 years, tiding most women completely through menopause. Another intrauterine system, Mirena, contains the hormone progesterone, which can actually decrease menstrual flow and can be used for 5 years.
Birth control pills: The newer, low-dose pills can be a good choice for nonsmokers over the age of 40. Failure rates are less than one percent. The Pill cuts down on menstrual cramps, and heavy flow reduces the risk of ovarian and endometrial (uterine) cancer. However, many women have side effects, and there is an increased risk of blood clots in women who use them.
Long-acting hormonal contraceptives: Depo-Provera, an injectable contraceptive, is effective for three months and can reduce heavy menstrual flow. However, it may cause weight gain and irritability. A variety of contraceptive implants are available, but they can cause irregular cycles. Long-acting injectable and implant progestins are highly effective but not widely used in the United States.
Sterilization: Female sterilization, or tubal ligation, is a highly effective birth control method and may be an excellent choice for women who have definitely decided not to have more children. It requires a minor surgical procedure and is permanent. A few women may experience pain or irregular periods as a result. Tubal ligation, during which the fallopian tubes are clipped, banded, cut, or cauterized, can be performed via an abdominal incision or laparoscopy. These methods require a general or regional anesthetic. Another option for female sterilization involves an office or outpatient surgical procedure during which a tube is temporarily inserted into the vagina to dispense small metal plugs that block the fallopian tubes. Male sterilization, a vasectomy, is also simple and highly effective.
"Morning-after" contraception: If taken within 72 hours of unprotected sex or sex during which another form of birth control failed, this pill is highly effective at preventing pregnancy. However, it does not protect against sexually transmitted diseases.
Abstinence: In this era of AIDS concern, this is the choice of many women because it is 100 percent effective as a contraceptive.
Expect the Unexpected Period
Most women have a predictable menstrual cycle in their 20s and 30s. In their 40s and early 50s, all bets are off. As ovulation becomes irregular and eventually stops altogether, a woman's periods may become irregular, closer together, light, heavy, unpredictable, or absent. Most of the time, this is just a nuisance, because these unpredictable periods will almost always appear at inconvenient times -- while on vacation or when a special romantic weekend is planned. It is a good idea to keep track with a simple record of your periods.
Several patterns should prompt a visit to your doctor. Frequent, very heavy periods can lead to anemia and fatigue. Irregular spotty bleeding or bleeding with intercourse can be a sign of polyps or fibroid tumors or even cancers of the cervix or uterine lining. Any bleeding more than a year after menopause merits a thorough investigation by a doctor.
While there are many changes your body will undergo during menopause, the most upsetting change may be to your physical appearance.
