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Menopause

Menopause

A woman has reached menopause when her ovaries stop releasing eggs (ovulating). Bleeding does not come every month as menopause approaches. A woman is considered no longer fertile once she has gone 12 consecutive months without any bleeding.

Menopause usually occurs between the ages of 45 and 55. About half of women reach menopause by age 50. By age 55, some 96% of women have reached menopause.

To prevent pregnancy until it is clear that she is no longer fertile, an older woman can use any method, if she has no medical condition that limits its use. By itself, age does not restrict a woman from using any contraceptive method.

A women near menopause choosing a method, can consider:

Combined hormonal methods (combined oral contraceptives (COCs), monthly injectables, combined patch, combined vaginal ring)

  • Women age 35 and older who smoke should not use COCs, the patch, or the vaginal ring
  • Women age 35 and older who smoke 15 or more cigarettes a day should not use monthly injectables
  • Women age 35 or older should not use COCs, monthly injectables, the patch, or the vaginal ring if they have migraine headaches

Progestin-only methods (progestin-only pills, progestin-only injectables, implants)

  • A good choice for women who cannot use methods with estrogen
  • During use, DMPA decreases bone mineral density slightly

Emergency contraceptive pills

  • Can be used by women of any age, including those who cannot use hormonal methods on a continuing basis.

Female sterilization and vasectomy

  • May be a good choice for older women and their partners who know they will not want more children
  • Older women are more likely to have conditions that require delay, referral, or caution for female sterilization

Male and female condoms, diaphragms, spermicides, cervical caps and withdrawal

  • Protect older women well, considering women’s reduced fertility in the years before menopause
  • Affordable and convenient for women who may have occasional sex

Intrauterine device (copper-bearing and hormonal intrauterine devices (IUDs))

  • Expulsion rates fall as women grow older, and are lowest in women over 40 years of age
  • Insertion may be more difficult due to tightening of the cervical canal

Fertility awareness methods

  • Lack of regular cycles before menopause makes it more difficult to use these methods reliably

When a Woman Can Stop Using Family Planning

Because bleeding does not come every month in the time before menopause, it is difficult for a woman whose bleeding seems to have stopped to know when to stop using contraception. Thus, it is recommended to use a family planning method for 12 months after last bleeding in case bleeding occurs again.

Hormonal methods affect bleeding, and so it may be difficult to know if a woman using them has reached menopause. After stopping a hormonal method, she can use a non-hormonal method. She no longer needs contraception once she has had no bleeding for 12 months in a row.

Copper-bearing IUDs can be left in place until after menopause. They should be removed within 12 months after a woman’s last monthly bleeding.

Relieving Symptoms of Menopause

Women experience physical effects before, during, and after menopause: hot flashes, excess sweating, difficulty holding urine, vaginal dryness that can make sex painful, and difficulty sleeping.

Suggestions:

Deep breathing from the diaphragm may make a hot flash go away faster. A woman can also try eating foods containing soy or taking 800 international units per day of vitamin E.

Eat foods rich in calcium (such as dairy products, beans, fish) and engage in moderate physical activity to help slow the loss of bone density that comes with menopause.

Vaginal lubricants or moisturizers can be used if vaginal dryness persists and causes irritation. During sex, use a commercially available vaginal lubricant, water, or saliva as a lubricant, if vaginal dryness is a problem.

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