It is typical of the peri-menopause that menstrual cycles change. Cycles that were typically 28 or 30 day intervals, become shorter. Menses can occur from 21-28 days apart, and occasionally two weeks apart. The bleeding changes also. Many women experience almost all of their bleeding on one or two days, with the remainder of the cycle being much less. Many women experience more bloating, breast tenderness, and mood changes premenstrually. Since women need contraception during this time, oral contraceptives can be used to even out hormonal changes, regulate the frequency of the cycle, and decrease heavy bleeding. While oral contraceptives are safe for most women in their 40's, women at high risk for cardiovascular disease, blood clots, and strokes may not be good candidates. Women who should not use oral contraceptives include smokers over 35 years old, women with hypertension, vascular disease, diabetes with vascular disease, ischemic heart disease, and those with multiple risk factors for heart disease.
There are several additional benefits of taking oral contraceptives in the peri-menopausal years besides efficacy for contraception. . Oral contraceptives can decrease hot flashes and night sweats, regulate the menstrual cycle in interval and decrease the amount of flow, decrease menstrual pain, and may decrease PMS. Oral contraceptives also decrease endometrial and ovarian cancer, and may maintain bone density and decrease fractures.
Oral contraceptives can be continued to the age of menopause. At age 55, most women have achieved menopause. If oral contraceptives are stopped, hormone studies can be done to determine if menopause has been reached.
Many of us remember that about 30 years ago IUD’s were taken off the market. There were many lawsuits related to infections caused by the IUD. Some of the IUD’s had strings that allowed bacteria to ascend into the uterus, and that caused infections that could lead to infertility. Several years passed and a copper-containing IUD’s were marketed to women over 40, who had completed their families. Many years later, the data has proven that IUD’s are safe, and the most effective contraceptive available besides sterilization. . Now, IUD’s are offered even to teenagers. The progesterone containing IUD makes periods very light, or even absent. This is a great treatment for women in their 40’s whose cycles have become heavy and irregular, plus it provides needed birth control!
IUD's are inserted in the office, and the procedure takes only about five minutes. The hormonal IUD exerts its contraceptive effect for 5 years.