The contraceptive needs of midlife women

Abstract

For those women who have not been contraceptively sterilized, midlife is a period of waning fertility. However, the occurrence of anovulatory menstrual cycles is unpredictable. Contraceptive methods also become increasingly contraindicated, both medically and physiologically. This article reviews the physiology of waning fertility and midlife contraceptive options, and discusses implications for helping women meet their contraceptive needs throughout the perimenopausal period.

PIP: Waning fertility, contraceptive use, beliefs about fertility, contraceptive choices, and implications for health care are discussed in relation to women at midlife. Contraceptive choices are limited, but pregnancy is still a possibility. assessment of women in midlife should include fertility status and future pregnancy goals. Teaching, counseling, and contraceptive techniques should be made available and be appropriate for current and future needs. Consideration must be given to a Women's physiological status as well as her personal preferences. If abortion is not an option, then reliable contraception is a necessity. The perimenopausal period between the ages of 35-50 is characterized by increasingly variable menstrual cycles and questionable fertility. In 1985, there were 4 live births/1000 women 40-44 years and .2/1000 women 45-49. Hypothalamic/pituitary/ovarian system changes and uterine integrity account for the decrease in fertility, i.e., change in cycle length. It can last from 1 to 10 years, with cycles ranging from 26 to 32 days. Prolonged cycles are not uncommon and signal many false alarms. During this transition phase, it has been shown that there are gradual increases is follicle stimulating hormone, particularly 5-6 years before menopause. luteinizing hormone levels rise 3-4 years before menopause. Sometimes there are lower levels of midfollicular and midluteal levels of estrogens and midluteal levels of progesterones. It is hypothesized that hormonal changes may be due to a depleting supply and eventual absence of primordial follicles, or follicles in various states of atresia, and hence no longer sensitive to gonadotropin stimulation. Inhibin is also decreased. irregularity does not mean sterility. Survey Data indicate that 26% of 40-44 year olds could become pregnant. There is sometimes the false belief that unprotected sex and not becoming pregnant means infertility. Contraception is recommended for 2 years after cessation of menses. Birth control pills are usually contraindicated. However, the FDA suggests low dose estrogen pills for those who do not smoke, are not obese, hypertensive, diabetic, lipidemic, or have a history of thrombosis, heart disease, or pregnancy-induced hypertension. The IUD is a possibility unless there is a history of problems with menorrhagia, fibroids, or prior cervical surgery. Barrier methods are the most commonly used: condoms, Contraceptive foam, diaphragms, either alone or in conjunction with rhythm or fertility awareness. The symptothermal method is recommended. Menstrual assessment, annually, should include length of cycles, length and nature of flow (number of tampons/napkins per day), and any changes in flow, spotting, metrorrhagia, or dysmenorrhea. Women's knowledge and feelings about fertility needs to be assessed.