A recent conversation with a friend opened my eyes to the number of women over 40 who, after coming out of long-term relationships, are delighted when they meet a new man but less than thrilled about having to decide what contraception to use. Many wonder if they need to use it at all. Hopefully the following information will help women like my friend.

Michelle is a 45-year-old recently divorced mother-of-two. She says, “I’ve just met a lovely new man and have some questions about contraception. “It’s something I haven’t had to think about for 16 years as my former husband had a vasectomy just after our youngest child was born.”

MICHELLE ASKS:

“Do I still need to be on contraception at my age? My periods have been a bit irregular for the past six months, which I guess means the beginning of menopause. Surely I can’t get pregnant if the menopause is starting? If I need to use contraception, can I take the Pill? That’s what I used before my ex had the snip but my blood pressure tends to be a bit high these days and I know that’s a problem when it comes to the Pill.”

“Yes, Michelle does still need to use contraception,” says Dr Christine Roke, the National Medical Director at Family Planning. Firstly, Michelle needs to make sure she’s protected against sexually transmitted infections (STIs). “Family Planning recommends that people of any age who are starting a new sexual relationship use condoms to protect against disease,” says Christine.

Both partners should be tested for STIs and use condoms until the results come back. While you’ll learn the outcome of tests for some STIs such as Chlamydia within a couple of weeks, it can take several months to get the results of syphilis or HIV tests. Michelle will also need contraception because there is still a chance she could fall pregnant, explains Christine.

“Unfortunately not all women realise they can still be fertile, even if they’re having irregular periods or other signs of menopause. They may still be ovulating so therefore they can still get pregnant.”

Family Planning does hear of women in their 40s getting pregnant unintentionally because they think they don’t need contraception anymore. “For some of them it can be disastrous,” Christine says. Women over the age of 45 should use contraception until they’ve had no periods for a year, while those under 45 should use it until they’ve had no periods for two years.

As for taking the Pill, if Michelle has high blood pressure it is very unlikely that her doctor will prescribe it for her. The Pill (also known as the combined pill) contains oestrogen and progestogen. Taking it may increase your risk of blood clots, stroke and heart attacks so doctors avoid prescribing not only for women who have high blood pressure, but also for women over 40, who may have an increased risk of clots and cardiovascular disease.

However, women in that age bracket who aren’t overweight, don’t smoke and don’t have high blood pressure, diabetes or a family history of heart disease may in some cases be given the go-ahead to use the Pill by their doctor, says Christine.

The mini-pill, or progestogen-only pill, is more commonly prescribed for women 40-plus because it doesn’t have the same health risks. There are drawbacks though – it has to be taken every day at the same time to be effective and has a slightly higher failure rate than the combined pill. It can also cause irregular bleeding.

Because contraceptive choices can depend on a variety of factors, including health and lifestyle, women like Michelle should talk to their doctor about their particular situation, says Christine.

Family Planning has a booklet written specifically for women over 40 who are having to make decisions about contraception, often for the first time in years. Called Update Me, it is free from Family Planning clinics or from www.familyplanning.org.nz

Q: “Do women on HRT need to use contraception?”

A: Yes. HRT (hormone replacement therapy) is prescribed to treat menopause symptoms and is not a contraceptive. So you may still be able to get pregnant if you have had periods in the past year if you are over 45, or the last two years if you’re under that age. Do not use the Pill if you’re on HRT. Talk to your GP about other methods of contraception. It can be hard to know whether your periods have stopped naturally when you’re on HRT because it causes monthly bleeding. That makes it difficult to tell if you are ovulating or not and whether you can safely stop using contraceptives, says Christine.

“Because the average age women go through menopause is 51, we usually advise those on HRT to use contraception until they are 52.”

OTHER TYPES OF CONTRACEPTION MICHELLE AND OTHER WOMEN OVER 40 COULD USE INCLUDE:

IUD – Or Intra Uterine Device. Sometimes called a coil.

Diaphragm – You do need good muscle tone to keep a diaphragm in place, which may be a problem for some women over 40 years of age.

Mirena – This is a small device inserted in the womb that slowly releases tiny amounts of hormones. As well as providing long-term contraception, it is also used to control heavy menstrual bleeding.

Depo provera – The contraceptive injection. However, Christine says women over 40 don’t really require such good contraception.

Natural fertility planning – Based on checking for signs of ovulation, which can be tricky if your periods are irregular.

Sterilisation – This is permanent but it involves pretty major surgery and, if you’re in your forties, you may feel it is not worth the trouble when you are only likely to be able to conceive for a few more years anyway.

DID YOU KNOW?

Fertility drops steeply after the age of 40 and, after 45, the chance of falling pregnant becomes minimal.