Contraception in menopause

[Randomchat]

I'm overwhelmed with hormones and medication and want to stop something.

I've been on hormonal contraception most of my adult life so I've never had reliable periods. For that reason the gp tells me contraception is suggested until age 55. We've also been using condoms for a while because of vaginal dryness.

I'm taking oestrogen gel (horribly allergic to 2 different brands of patch), progestogen pills and a progestogen only contraceptive (have an odd shaped uterus so don't get on with coils). Unrelated, but I've also started medication for glaucoma recently.

I'm considering stopping the hormonal contraceptive and just using condoms. I spoke to the practice nurse today who said that the chances of getting pregnant at 51 are really small but not zero. Properly using condoms massively reduces the risk. So the risk would be tiny.

I want to stop taking it because I'm slightly overwhelmed with the amount of medicines I'm taking. Also the amount of hormones I'm adding to my body for one reason or another. If it's not entirely necessary I'd like to cut it out.

But I've been on hormonal contraception pretty much forever and I feel a bit terrified about stopping, like I'm bound to get pregnant aged 51 the very first time we have sex. Even though we would still use condoms.

I'm also not sure how I would know I was pregnant since I don't have periods. I didn't have many early symptoms when I was pregnant. Should I take a test every month for peace of mind?

I don't know why I've got a bit fixated on this tiny pill. I would actually love to just stop interfering with my hormones altogether and just be however my body is meant to be, but I don't think it would be pretty, based on how I was feeling before starting HRT. So do I stop this one part of my hormone regime? Or will it not make much difference and I should just keep taking it and stop thinking about it so much?

Please talk some sense into me. Thank you

You might want to consider HRT sooner if it's an option for you.

The protective bone and heart health benefits are increased the younger you start to take it.

OP this may be a silly question, but if you're with a long term partner and no plans for more children, could he not have a vasectomy?

Another poster brought his up. Given OP is possibly post menopausal now and certainly would not go full term, is it even an option to consider?

Sorry haven't RTFT but yes of course - contraception shouldn't cause that much anxiety. Anything that helps is an option to consider

I think the OP has already covered this when asked.

Also what a private consultant does is not the same as a GP.

Who is your doctor, out of interest?

This is quite a strong reaction 🤨
I’m guessing you felt quite definitively that if anything happened to you - god forbid - that your DH should not have the chance to one day build a family with anyone else. Not everyone would feel the same.

GPs in general will just keep feeding out various drugs and then it gets confusing as to what does what. What you need is a one stop simplification from someone who knows women

I think maybe this is it. We had a reasonable discussion about hrt options then she was like "oh and you'll need this for contraception" as a bit of an add-on.

I've read all your posts and I'll have a think.

I'm slightly bemused by all the talk of vasectomy. I honestly don't know anyone who's had one. Among all my friends it's generally still the women on contraception. Long-acting things like the implant for most. I know one woman who's had a sterilisation after her 4th c-section. That's it. And we do generally talk about these things. We're not massively secretive. Unless they're all lying for some weird reason.

I know a few men who've had one in their 40's because they dont want any more kids. Ever.

In the context of a long term relationship as they'd had the amount of children they planned.

I agree.

I never wanted DH to have the snip (and neither did he) because if, God forbid, me, or my kids (or all of us) had died, I wanted him to have the option of children with a new partner, certainly up to the age of 50.

I do know at least 3 couples whose circumstances changed and the men were in their early 50s when they became fathers for the second time.

It's not a one-size fits all and is a very personal choice.

But you do accept that circumstances can change and minds can change too.
It's absolutely final, whatever happens to their existing children or current partner. It's interesting to look at the stats for snip reversal, which shows it's not always the right decision.

@OrdinaryGirl
I don't think you're considering this from an age pov for a start!
My husband was already 46 when our daughter was born. God fobid say I passed exactly at that point. At what point in his life do you think it would be acceptable for him to have the opportunity to meet someone else and start a new family with her? Bearing in mind also he would be taking full-time care of his newborn?
He never would have done this because it simply would have been selfish.
Option B - Separate and leave me with a young child so he could "move on" and have another child with a new woman. Again, not a decision that my husband would ever, ever have made. He would never become an absent father like so many men seem to end up choosing.

@Randomchat Unfortunately most men put the responsibility of contraception upon women.

@JinglingSpringbells See my post re age!

Not talking about separation obviously.

Fair point about age. My husband was 49 when our twins were born but I think you’ll agree this is not typical for most couples.

I don’t think it’s a good thing for a couple if a vasectomy ends up being a decision that the guy is shamed or guilted into rather than offering freely. General point, not saying is the case for you or would apply to OP.

@OrdinaryGirl Out of interest, did your husband go on to have a vaesectomy if he was 49 when your babies were born?

The condoms are fine OP, stop the other pill if you don’t want it.

OP just condoms is absolutely fine - as long as you both actually stick with it, obviously! 10+ fertile years since children her & no unexpected 3rd child!

I would have far preferred a vasectomy as our option, particularly after significant childbirth impacts on me - but DH is a chicken, so there we are.

For those on long term contraception, particularly injections & implants - we don't yet talk enough about the effect that reducing oestrogen levels during our fertile years has on laying down bone mass. So anyone long term using these methods is likely to enter menopause already more vulnerable to osteoporosis.

Only one factor among many to weigh up. But definitely not a minor one. And tips the balance towards 'come on bloke in this long-term relationship, time to do something about your part in preventing this baby-making equation'. Still wouldn't tip the balance for mine 🙄

But glad I didn't pay for his uselessness with my ability to withstand tripping over & landing on the floor without a 3 months stay in hospital in 20 years time...

For those on long term contraception, particularly injections & implants - we don't yet talk enough about the effect that reducing oestrogen levels during our fertile years has on laying down bone mass. So anyone long term using these methods is likely to enter menopause already more vulnerable to osteoporosis

See I just don't understand enough about any of this. I thought I was quite well informed actually about the oestrogen and progesterone elements of hrt. But all the other stuff around the edges, I really don't have a clue.

I took the depo provera injection for years without being warned of the small increased risk of a brain tumor (I've forgotten its name).

And my mum has quite severe osteoporosis so I should know more.

I also thought my GP sounded fairly knowledgeable but maybe actually just gave me the basic options.

I need to go and read more.

For those on long term contraception, particularly injections & implants - we don't yet talk enough about the effect that reducing oestrogen levels during our fertile years has on laying down bone mass. So anyone long term using these methods is likely to enter menopause already more vulnerable to osteoporosis.

https://theros.org.uk/information-and-support/causes-and-risk-factors/medicines-that-increase-your-risk/depo-provera/

How does Depo-Provera affect bone health?
Depo-Provera is a long-acting contraceptive injection. It contains a hormone called medroxyprogesterone acetate. You have it as an injection into a muscle or under the skin.

Studies have shown that bone strength decreases by a small amount in people using Depo-Provera. This decrease is greater in people who use it for longer. It is also likely to be greater in younger women than older women.

Women taking Depo-Provera may have a higher chance of breaking a bone. But overall, this risk is low.

Once you stop having injections, bone strength improves and returns close to its earlier level. If you already have osteoporosis, your healthcare professional may advise you not to use Depo-Provera. A different contraceptive may be more suitable for you.

We need more research to know whether long-term use of Depo-Provera in younger women increases the chance of fractures later in life.

Implants do not suppress estrogen to any level where bone mass will be affected.

I did but many men still father children at 46+.
I know men who had a 2nd family in their early 50s.

There is research that shows implants definitely DO reduce bone density:
https://w1.med.cmu.ac.th/obgyn/files/2022/01/362-Pongsatha-2010-3.pdf

For 2.5+ year users of Implanon (sold in the UK as Nexplanon, active ingredient progestin etonogestrel) vs an age & BMI matched non-implant control group, it found around 8% more implant users with bone density T score of -1 to -2.5 measuring arm bones, around 6% more measuring thigh bones, and around 15% more measuring lumbar spine.

A T score of -1 to -2.5 is considered osteopenia by the NHS. This study is looking at fertile age women, not those post-menopause. It's not a tiny percentage that were affected! (several other studies only looked at 6 month users & they are often quoted in the 'has no effect' discussions, but let's be honest, 3 years on an implant is standard and many will do that 3x over after children)

OP, there's plenty of proactive steps you can still take to reduce your osteoporosis risk. Knowing where you are currently is the best start. If you have a family history of osteoporosis, imo a GP never should have prescribed you dexo-provera, but it's never too late to improve your bone density! Ask your GP now if you're able to have a DEXA scan to assess your risk/find out your current T-score. If they don't consider the injection/family history risk high enough to find out, you can get one for about 150 quid. They take about 30 mins, you lie down fully clothed on an open table, it's very straightforward.

If you're in any way low, you can improve your calcium intake, ensure you have oestrogen HRT and add some jumping & weight bearing exercises to your routine to improve how much bone mass you retain.

Below -1.5, your GP might want to prescribe some loss-reducing medication so you hold onto bone easier.

Below -2.5, I think they stop recommending jumping as part of your exercise because you're actually quite high risk of breakage. But weight bearing exercises can still help & it is still possible to improve your scores before old age.

Knowledge is power! I'm of the generation that watched Maggie Philbin get diagnosed live on air with osteopenia on Tomorrow's World. The science around what hormonal contraceptives do long term to female bone strength is still catching up 30 years later...

He offered to, but I was happy using the coil.

@JinglingSpringbells Selfish men, yes.