Contraception methods in perimenopause

Fertility declines sharply from 40 years, but it is simply a matter of probabilities, which are lower, but not non-existent until the. For this reason, if the woman does not want to become pregnant, she should continue taking measurements until one year beyond the date of the last period, a moment that we define as menopause. It is true that pregnancies at these ages are rare, but all gynecologists have some anecdote of pregnancies close to fifty, and some even after.

Contraceptives according to age

The offer of is the same as for other ages, but the patient is different and we must adapt to that new profile.

Up to 50

In women who do not have risk factors (hypertension, heart disease ...) and non-smokers, the classic hormonal contraception up to 50 years. The general idea that birth control pills should be abandoned at certain ages is wrong. They can be maintained in healthy patients and adjusted to the minimum dose of estrogen that allows us to control the menstrual cycle well. In patients with hypertension or smokers we can opt for the pills of only progestogens, which do not provide additional cardiovascular risk but do not achieve the cycle control that the combined ones (estrogens + progestogens) have.

Keep in mind that hormone therapy at this age also has additional advantages:

• It helps us maintain bone mass and.
• Lowers the risk of colon and ovarian cancer.
• It controls the amount of menstrual bleeding, which is sometimes very heavy in women at this stage.
• It controls the periodicity of the cycle, which is also usually altered in the borderline years close to menopause.

The same is applicable to the, which are also estro-progestin combinations but with the difference that we cannot play with the doses as the pills allow us.

At the age of 50 ...

Treatment should be suspended to be able to assess whether the patient is menopausal and no longer needs it, since we must not forget that the rules during contraceptive therapy would continue to come with regularity infinitely, and that there is no way to diagnose menopause with a few determinations hormonal values ​​since the values ​​are modified by effect of the treatment.

Long-term or undefined methods

Anyway, the profile of women over 40-45 years old, who have usually already decided definitely not get pregnant again, and have a stable partner, makes them more inclined to seek a more long-term or even definitive method. This is the case of surgical treatments:

• Vasectomy (in men).
• Tubal ligation (in women)

These methods allow couples who opt for this option to definitively forget about the subject but which has precisely that disadvantage, that rectifying requires a new complex surgical intervention and that is not always possible.

Intra Uterine Device (IUD)

It lasts for about five years, and they also allow you to forget about the issue, and if after five years you still need contraceptive protection, they are replaced by another for five more years. There are basically two types of IUDs, the copper ones and the hormonal ones.

• The Copper They work by the spermicidal effect of copper and the negative effects that this has on the endometrium, they have the disadvantage that they can increase the volume of menstrual bleeding, so it is inadvisable in women with heavy periods.
• The hormonal IUD option It is very interesting, because its contraceptive effect is based on limiting endometrial growth, thereby reducing the amount of bleeding, causing few or non-existent periods, without affecting the hormonal status of the patient. They only carry progestogens so they can be used in patients who have this option. This option is highly indicated in women who at this age cycles increase in frequency and in duration and amount of bleeding. An additional advantage is that the woman who enters menopause with the progesterone hormonal device will lessen the symptoms of hot flashes should I have them and it will make the transition smoother.

All these methods protect us from unwanted pregnancies, but not from sexually transmitted diseases, so in sexual relations outside the normal healthy and monogamous partner we must continue to use preservative at any age, in perimenopause and also after menopause.

If you have any questions about which contraceptive method to use, you can consult a gynecologist included in the medical chart of the.

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