You may notice your periods becoming irregular in your late forties, although this can occur quite naturally some years earlier or later. As periods become less frequent, your fertility declines. Women of fifty-five have become pregnant, however, and one Californian woman gave birth at the ripe old age of fifty-seven years! The changing output of sex hormones by the ovaries, as the menopause approaches, is responsible for this menstrual irregularity. For most women, irregular periods last between two and seven years, though the range is a,few months to eleven years. If you are irregular for many months, this can be a confusing and stressful time because of both the bleeding and the risk of an unplanned pregnancy.
In order to meet contraceptive needs in their forties and fifties, some women use the Pill or long-acting contraceptives like Norplant, a hormone-containing pellet that is implanted under the skin. These tend to mask changes in menstrual bleeding that indicate the approach of menopause.
This was the case for Janet, a Pill-user since having an IUD removed ten years previously. When she was fifty-three and, with no change in her Pill-induced bleeds, experienced a few hot flushes, she asked her doctor if these could be menopause-related. Her doctor recommended that she use a non-hormonal form of contraception for a while to see if her menstrual periods occurred, thus allowing an assessment of what was happening to Janet’s own hormone production. After she and her partner had been using condoms for a few months she had a menstrual bleed. She then faced further choices — whether to continue using condoms until her bleeding disappeared for a full year, or to resume the Pill for another year before repeating the same sort of Pill-free ‘trial’. Janet chose the first of these options, and what turned out to be her final period occurred four months later. According to a recent Australian study, an increasing number of couples choose sterilisation of one or other partner – at this stage of life another option again.
It is important to point out that the Pill is not a suitable choice for any woman over thirty-five who has a substantial risk of heart and blood vessel disease. Indications of high risk include smoking, high blood pressure, unacceptable blood fat levels, and a family history of heart and blood vessel disease mainly associated with the early death of a relative. If you fall into any of these categories, your risk of suffering a heart attack, a serious blood clot disorder or a stroke markedly increases.
Both HRT and the Pill typically include the hormones oestrogen and progestogen, a synthetic form of progesterone, but the hormone doses in HRT tend to be considerably lower than in low-dose Pills. While women on the Pill who smoke have a measurable increase in their risk of heart disease, the heart health of smokers on HRT does not seem to be jeopardised. In fact, for such women, HRT may confer important health benefits.
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