Hi and welcome to my VLOG. So this week is a short and sweet VLOG but the
contents are really really important. And the reason I'm doing it is because it's
a question I get asked all of the time, on both the radio show and in the Latte
Lounge, where I'm the resident GP. So the question is.. menopause or perimenopause
and contraception - what's needed and what do you do? So here we go.First of all
I think some definitions will really help. So what is perimenopause? So
perimenopause can start 10 years before you actually go through menopause and
have your very last period. So menopause itself is when your periods stop
completely, but perimenopause is the 10 years leading up to that.
So on average in the UK women go through menopause when
they're 51. So that's when their periods stop completely, forever. This means you
can be perimenopausal for your entire forties, so it's a long time. For
some women, they have periods into their late fifties. So even though the average is
51, it varies dramatically. And it tends to be quite genetic; so when your mum
went through menopause and your sisters. So fertility, when you need contraception
to stop getting pregnant, actually declines after about the age of 37, and
definitely after the age of 40. But, and this is a massive but, even though
potential declines and even if your periods become irregular (so you don't
have one every month) as long as you're having a period from time to time
you are still potentially fertile! And you still can get pregnant and it does
happen. So most women are considered to no longer be fertile after the age of 55.
So what do we do between the ages of 40 and 55 if we don't want to get pregnant?
So that's what I'm going to cover today. So when can you stop using contraception?
That's the question I get asked as a doctor much of the time. Well if you're
using a non hormonal contraception such as condoms or diaphragm
you can reliably stop using contraception two years after your very
last period (so no periods at all for two years) if you're under 50 and if you're
over 50 you can stop one year after your periods have stopped completely.
However if you're already using hormonal methods; so the combined pill or the mini pill,
then it's not so clear and it's difficult to tell, almost impossible, when
this point has been reached, because they interfere with your periods. On the mini
pill you may have no periods or irregular periods. And on the combined pill
you'll have monthly periods but you don't know if they're real periods or just
induced by the hormones. An isolated blood test for follicle stimulating
hormone (which is the one that we use to indicate whether or not you're going
through perimenopause or menopause) are not reliable. They just aren't, they can
vary dramatically. So one month normal and the next month could look like
you're menopausal. And if you're on the combined pill they're not reliable at
all. So you can still get pregnant if you've had a blood test that suggests
that you're menopausal and if you are having periods, however irregularly.
And then it becomes even more complicated....what if you're on HRT?
and some women are of course on HRT and the mini pill, and there's a reason for that.
So HRT in any format (tablet, patch, gels) contains very low doses of hormones and
those doses are not high enough to act like a pill, even though logically it
might seem like that's what they should be doing they're not! You can still get
pregnant taking HRT; it is not a contraceptive. And believe me women in
their early 50s, on HRT who think they're protected do get pregnant.
And if you don't want to be pregnant at that age, obviously that can
be devastating. So if you're on HRT and you've been on it for a period of time
so you don't know whether or not your periods have stopped for long enough to
make you infertile as it were, you can use all of the normal methods:
barrier, mini pill, intrauterine devices or systems as well as HRT. You
just use them alongside. So just to break that down a little bit better, I'm going
to go into the details over that because this is what people want to know...
what do they do? So the first approach is that whether perimenopausal or
not, over 40 you still need contraception. And for you the choice is personal. How
effective is the choice? What are the risks and the side effects? What's your
personal preference, which always has to come into account. And are you on HRT or
not? And then you start thinking about the choices. So let's assume you're on
HRT, (because that's what this VLOG is about) and you use barrier methods; so if
you're quite happy using condoms or a diaphragm alongside your HRT no other
methods are needed. You're protected if it's a condom, against sexually
transmitted infections and sexually transmitted infections have gone up
amongst women who are over 50 because we're seeing marriage break
downs and new partnerships and people are having sex with people other than
their partner, in times when they wouldn't have done that previously because
society was different. So barrier methods give you that protection as well. Although
they need some planning so again you have to decide what works for you.
The mini pill is probably the choice that most women use when they're on HRT,
because it's safe to take up to the age of 55, when you're considered no longer
fertile. And you can safely add it to your HRT and it's just one tablet a day
so that's probably one of the most popular choices. The copper coil; so the
copper coil will protect you against pregnancy for sure. You don't have to
think about it, there's no planning involved and it can stay in place for up
to 10 years. There's no additional hormones being added to your HRT so it's
quite a nice method to use. However it does not supply you with the
progesterone of other coil systems that can be used as part of HRT.
So if you have the copper coil you will still need an HRT that has both progesterone
and oestrogen in it. However the Mirena coil or IUS does provide you with the
progesterone that you need for HRT. So if you have the Mirena coil all you need to
have as part of your HRT is the oestrogen; as a gel, patch or tablet. And that actually
makes it quite simple for some women. They don't have to think about
contraception, they have the progesterone element covered and it works really well
for many women. So that's another alternative and it's licensed for four
years as the progesterone side of HRT but you can actually leave it in for 5.
So quite often you won't need that changed if you have it put in at 50, you can go through to 55 and be safe
against pregnancy and have that part of your HRT covered off. So that's quite
nice for women who don't like to take progesterone because of side effects. And
the nice thing about that as well is that if you start it younger, so if
you're in your forties when you start needing HRT, you can actually just have
it changed every five years and it's literally a take out and put back. And
it keeps you covered for your HRT so the IUS or Mirena coil is another
really good choice that some women prefer. So I'd say the two most common
types of contraception that women use alongside their HRT are the
mini pill, which goes on top of HRT, or the Mirena (IUS) coil which actually acts as
the progesterone part of your HRT. So it's reasonably simple even though it quite
often doesn't appear that way. And to summarise the whole affect; fertility
definitely does decline over the age of 40 and you are much less likely to get
pregnant in that age range but women do, all of the time! And whilst you're still
having periods of any type, any regularity, there is a chance that you
might just throw out one good egg and that's all it needs, (obviously to meet one
good sperm) and you could get pregnant! You do need therefore practical safe
contraception to cover you for this period if you don't want to be pregnant (and some women do).
You need contraception until you've been without a period for two years if you're under 50 or for one year if
you're over 50. But if you are taking hormonal contraception in that period
it's very difficult to tell when you've hit that point, so the safest assumption,
and the one recommended by the BMS, is that you are still fertile until the age
of 55. So add contraception to your HRT. And as I've said HRT is not a
contraception on its own. And you can still get pregnant on it if you haven't
added other contraception. And if your periods were not, as I've said, finished
for two years or one year depending on whether you're over or under 50 when you
start HRT, then you definitely need some contraception. so hopefully that's a very
complex subject that people really struggle with covered in a very simple
way for you today. And I hope you enjoyed it. Please do ask me any questions after
the VLOG, I'm more than happy to answer them or in the Latte Lounge or the
Menopause support network - all of those places where I operate as a doctor giving
my advice, and I'm more than happy to answer. But hopefully that's given you
the basis; So HRT is not a contraception. You do need to add something to it and
the choices I've covered for you. Thanks for listening as always, it's been a
pleasure, it's always a pleasure. And let me know if there's any topics that you
want me to cover. Take care, bye for now.