Contraception and Perimenopause
What are our options
The first thing to say is that once you’ve reached full menopause — that’s 12 months after your last period if you’re over 45 and 24 months if you are under — then your reproductive days are behind you.
But in perimenopause it can be a bit of a minefield. Perimenopausal babies happen. Sometimes hoped for. Sometimes a surprise. Sometimes a shock.
If you’re still hoping to get pregnant and think you’re perimenopausal then it’s worth seeking medical advice.
Why we need to think about contraception
The reason that perimenopausal surprises happen is that sometimes we can think we’re finished ovulating and we haven’t. But also if we’re reliant on knowing the safe times of the month we can get caught out because our ovulation probably isn’t following a regular pattern any more.
We may also find that our tried and trusted methods of contraception — like the pill or mini-pill are no longer appropriate for us as we get older. You’re advised not to take the combined pill (or the contraceptive patch or ring) beyond the age of 50 or the mini (progesterone only pill) beyond the age of 45. Some doctors may advise you to stop before that — depending on your risk of blood clots which is higher with oral contraception than it is with most modern forms of HRT. You may be asked to stop around 35 if you’re a smoker.
Modern HRT is much safer than oral contraception because the oestrogen comes through the skin and the progesterone is usually much more similar to the molecules in your own body. But it doesn’t act as contraception.
There’s also the complication that the doctor might ask you to come off hormonal contraception to find out where you are up to with your menopausal transition. And of course if you don’t know when you reach full menopause you won’t know when you can safely stop contraception.
Combined Oral Contraception
This is a pill containing oestrogen and progesterone, sometimes it’s just called the pill. You would not be able to take this at the same time as HRT
Some doctors even use the combined pill to manage menopause symptoms. You’d need to weigh up the risks and benefits with your doctor if you were considering that. They would include when to take a break to find out whether you’d reached full menopause or not.
Progesterone Only Contraception
This includes the progesterone only pill or mini-pill and also contraceptive injections and implants.
Because they don’t contain oestrogen they are unlikely to help with many menopause symptoms as it’s the shifts in our oestrogen levels that cause most of our symptoms.
However these methods might help with menstrual bleeding.
These don’t give you enough progesterone to protect your womb so you wouldn’t be able to use them as the progesterone part of your HRT.
But you can take them alongside your HRT with another progesterone. The practicalities of that would need to be discussed with your doctor.
The Coil
The Mirena coil releases progesterone. It prevents pregnancy for up to 5 years. It can also be really useful during perimenopause to manage bleeding.
The Mirena coil does give you enough progesterone to use as the progesterone part of HRT without taking additional progesterone.
As the progesterone in the Mirena coil hangs around the womb rather than going all round the body in the blood stream so some women who are sensitive to progesterone find it useful, although others feel it does affect their whole body.
There is also a copper coil which doesn’t release progesterone that might be considered whether or not you take HRT.
And there’s surgery..
The other options of course whether you are taking HRT or not is for one of you to have surgery that makes conception more or less permanently impossible — a vasectomy or a tubal ligation.
Or barrier methods
That pretty much leaves you with barrier methods — condoms, sponges and caps. The sponge can dry you out which is not great at this time of life. If you do start to become uncomfortable as your vaginal tissue changes then your doctor will be able to help, with vaginal oestrogen or non-hormonal moisturisers and there are also many helpful over the counter products. It’s worth noting that caps and condoms are all likely to be damaged by coconut oil or other oils, which can be wonderfully soothing lubricants.
And also…
It’s also worth remembering that not all sex is penetrative and if I may throw in a slightly inappropriate metaphor there are many ways to skin a cat.
And of course, not all sex involves men. In which case the world is your oyster. Or something like that.
Originally published at https://www.linkedin.com.
