Contraception For Midlife Women. Perimenopause.
Contraception is important during perimenopause, the time leading up to menopause, if pregnancy is to be avoided in midlife. During perimenopause it’s harder to predict ovulation, women may have irregular menstrual cycles shorter or longer), and if sexually active they may become pregnant.
Women who do not desire pregnancy should use contraception until menopause, which is confirmed after 12 months with no menstrual periods.
Because age is a risk factor for cardiovascular disease and venous thromboembolism (blood clots), birth control containing estrogen, “The Pill”, should be used with caution in women with other risk factors like obesity, smoking, diabetes, high blood pressure, and migraine headaches. For these reasons some women may be prescribed progesterone-only contraceptives.
Intramuscular injection and oral tablets are available in Canada under the brand names Depo-Provera and Micronor respectively.
According to The North American Menopause Society, “intrauterine contraceptives offer safe, highly-effective, convenient, and long-term contraception”. There are two types of Intrauterine Device (IUD), copper (hormone free, sold in Canada under the brands Mona Lisa and Liberte ) which may increase menstrual bleeding or menstrual cramping and the levonorgestrel-releasing intrauterine system ( Mirena and Jaydess, and others brands are available in Canada).
The hormonal IUD is a particularly suitable method of contraception for women with heavy menstrual bleeding since it causes uterine bleeding to decrease and even stop over time.
Some women may opt for non-hormonal methods of birth control like condoms and diaphragms which are less effective than hormonal methods of contraception but also have fewer adverse effects.
And if all else fails there’s emergency contraception (EC) available over-the-counter without a prescription, (in all provinces of Canada, except Quebec). The best-known brand is Plan B and may be taken up to 72 hours after unprotected sex although the effectiveness decreases with time. The most effective form of EC is a copper IUD inserted within 120 hours of unprotected intercourse.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
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