How to protect yourself after 45. The best contraceptive candles. Contraception in different age groups

In youth, few people think about age. It seems to many that the 40-year milestone will not come soon. Therefore, not everyone thinks about their future health. After 40, all women have a special period in the body, in which production is sharply reduced.

It is this hormone that is responsible for the state of women's health, affects sexual function, skin condition.

Estrogen deficiency in the female body leads to various consequences. Among them may be:

• depression;
• insomnia;
• illness;
• causeless change of mood;
• irritability;
• headache;
• decrease in sexual desire;
• fading of the skin.

To maintain a stable level of hormones in a woman's body, a whole set of hormones is used. Hormone therapy allows women at the age to return a sense of youth, as well as normalize their health and avoid serious diseases.

Necessary conditions to start taking hormones

Hormone therapy for women over forty should not be self-administered. Specialist consultation required. To prescribe hormones, the following conditions are required:

• obligatory visit to the gynecologist in order to identify failures in the hormonal system;
• a complete blood count;
• examination of the genital organs for the presence of tumors;
• examination of the cervix for the presence of tumor markers and in order to study its microflora;
• testing for malfunctions in the thyroid gland;
• performing liver tests;
• visiting a mammologist in order to study the condition of the mammary glands;
• a blood test specifically for hormones.

If there are no contraindications to start therapy, then the doctor can advise which hormones should be taken.

Cases when hormone therapy is unacceptable

It is important to point out cases when it is better for women over 40 to refrain from taking hormones. These are the following cases:

• having problems with the liver, oncological diseases, high risk internal bleeding, thrombosis in the vessels;
• age over 60 years, when hormone treatment can lead to complications;
• intolerance to drugs based on hormones;
• More than 10 years have passed since the onset of menopause.

In these cases, hormone therapy can be harmful. women's health. It is necessary to consult with your doctor in advance regarding the use of hormonal drugs.

Varieties of drugs for hormone therapy in the form of tablets

Hormone therapy preparations can be produced in the form of suppositories, ointments, patches, subcutaneous implants and tablets. Special attention should be focused on the last and most common form hormonal drugs- tablets.

There are two main female hormones in pills for taking at 40:

• estrogen;
• progesterone.

Estrogen is multifunctional. This is the main female hormone that improves the condition of the heart, blood vessels, blood, brain, bones. He is responsible for sexual desire and skin condition. Participates in the activity of all major organs of the female body.

Progesterone acts on the uterus, preventing it from growing too much. He is also responsible for the production of breast milk and is involved in the process of pregnancy.

Overview of popular hormonal drugs

There are 7 most popular and effective drugs in the form of tablets recommended for women over 40 years of age: These include:

• "Livial";
• "Estrofem";
• "Klimonorm";
• "Kliogest";
• "Femoston";
• "Trisequens";

"Livial" is recommended for women suffering from high blood pressure. It is also recommended by doctors for the prevention of osteoporosis. The drug has its own interval of reception - 5 years. After that, it is important to take a six-month break. Prohibited for use during pregnancy.

"Estrofem" has a good effect on the heart and is a reliable prophylactic hormonal remedy for cardiovascular diseases. Contains plant-derived estrogen. The tool should not be used by women who have problems with the stomach and kidneys.

"Klimonorm" is more often prescribed to those women who have undergone surgery to remove the uterus or ovaries. It has its own contraindications for women with stomach ulcers, jaundice or diabetes. Women taking this hormone should remember that it is not a contraceptive.

"Kliogest", like "Livial", is recommended to drink as a prevention of osteoporosis and high blood pressure. But this medicine has a lot side effects. They are expressed in the form of colic in the liver, headaches and bleeding in the internal organs.

Femoston is a universal hormone in tablets. The drug can be used by both women and men for the treatment of prostate. In women, the remedy strengthens well bone tissue and vessels, but has Negative influence to the stomach and intestines. This medicine should only be taken under constant control doctor.

"Trisequens" contains two hormones at once. In addition to estrogen, it contains the hormone progesterone. The drug well relieves pain during menopause. May cause vaginal itching and swelling of the legs. It is highly recommended for women with malignant tumors. It is unacceptable to take with internal bleeding.

"Proginova" is prescribed as a drug that replenishes the blood of women. From the appearance of itching on the skin can be distinguished. The tool is often prescribed to women with removed appendages.

Taking phytoestrogens as part of hormone therapy

It is known that hormones are able to produce some types of plants. Among such plants is cimicifuga. It contains phytoestrogens, which are useful for women who have crossed the line of 45 years. Created on the basis of cimicifuga hormonal drug"Chi-Klim". It is available in both tablet and ointment form.

Phytoestrogens, which are part of this drug, have the following effect:

• smooth out the manifestation of menopause;
• reduce inflammation;
• relieve pain during menopause;
• improve skin condition;
• increase sexual desire;
• reduce the appearance of wrinkles and age spots on the skin.

Phytoestrogens act as a substitute for estrogen. In this case, hormone therapy will be safer than taking strong drugs. Qi-Klim is relatively safe means. Side effects can include allergies and digestive problems. Most often, the tool acts as an additive. Not recommended for women with malignant tumors.

Taking birth control pills containing hormones

After 40, a woman's sex life does not stop. But there are factors that affect its quality. Climax and hormonal changes can cause disturbances in sexual desire, which can result in various diseases.

Do not forget that even in adulthood, a woman can become pregnant. Childbirth at this age is fraught with numerous complications, so not every representative of the weaker sex will decide on pregnancy. To avoid unplanned pregnancy, women are advised to take birth control pills containing hormones.

Any contraceptive hormonal therapy has its own contraindications:

• migraine;
• high pressure;
• problems with the circulatory system (for example, varicose veins);
• angina in a chronic form;
• excess weight;
• diabetes;
• oncological diseases.

The most effective drugs are in the form of tablets. They have high percent efficiency. Most often on sale there are such drugs:

• "Silest";
• "Regulon";

"Silest" affects the egg and reduces its work, and also makes the walls of the uterus soft.

"Regulon" acts as a good prevention of the appearance of uterine fibroids in women. This hormonal contraceptive normalizes menstrual cycles.

"Jess" has a small number of side effects and is even used to treat gynecological diseases. Well removes water from the female body, removing puffiness. Available additional drug, called "Jess Plus".

Marvelon operates multifunctionally. In addition to the contraceptive effect, it also improves skin condition. Additionally, it reduces the growth of hair on the body.

As additional contraceptive drugs, there are:

• "Trisiston", holding back sperm by secreting mucus into the vagina;
• "Janine", changing the composition of the uterine mucosa during ovulation;
• "Trikvilar", which makes ovulation difficult;
• "Novinet", which maintains a stable background of hormones in a woman;
• "Femoden", which regulates menstruation and fights anemia.

The gynecologist must decide which hormonal contraceptive pills should be taken by a particular woman. Self-administration of hormonal agents is unacceptable due to the risk of complications. Any at the age of 40 are prescribed taking into account the personal characteristics of the patients.

Features of taking hormones

Any need to drink dosed and in a timely manner. For most hormones, the approximate period is 3 weeks. Then a pause is made for the period of menstruation (about 7 days). At this time, you need to monitor your health. If you experience pain in the head or discharge, it is recommended to immediately stop taking hormonal pills.

Women who lead frequent sexual life, it is important to remember that simultaneous reception hormonal contraceptives and antibiotics significantly reduces the effectiveness of the former. In such cases, a protected act is needed with the use of condoms and various lubricants and vaginal gels.

Hormonal drugs that fight menopause and cancer

In addition to the above funds hormone therapy let's say taking such drugs in tablets that fight not only with the manifestations of menopause, but also serve as a prevention of cancer in women. These funds include:

• "Chlortrianisen", taken in the treatment of breast cancer;
• "Microfollin", correcting the cycle of menstruation;
• "Vagifem", which relieves pain during menopause;
• "Estrofeminal", acting analgesic in menopause.

It is important that women drink these drugs with strict adherence to the dosage and pauses between doses during menopause.

It turns out that follicles with eggs remain in the ovaries for 3-5 years after the cessation of menstruation, which explains the far from rare cases of pregnancy.

Therefore, according to the recommendations of the World Health Organization, contraception is recommended for women before menopause and the absence of menstruation for 1 year over the age of 50 and for 2 years for women under 50 years of age.

By the age of 40, most women have resolved the issues of family planning and the number of children, so an unplanned pregnancy over the age of 40-45 usually ends with an induced abortion and is often complicated by inflammatory diseases of the genital organs, the development of uterine fibroids, endometriosis, severe course menopause and, most dangerously, in the future it is the background for the development of cancer in the uterus and mammary glands. As we can see, even at this age, abortion can have ill effects on a woman's health.

Main difficulties in dealing with the issue of contraceptive methods in women transitional age associated with a number of features of this period of life. This is first of all a large number of concomitant diseases, which are a contraindication to the use of many contraceptives, and possible side effects. The frequency of gynecological diseases at this age reaches different sources 44-65%, among them chronic inflammatory processes, fibroids, prolapse of the uterus and vagina predominate.

In addition, 10% of women of this age have previously undergone surgery on the genitals. Not to mention diseases of other organs and systems, which are a limitation for the use of hormonal or intrauterine contraception.

All this suggests that contraceptive methods during this period of life should be as gentle as possible and take into account all the existing problems in the body. That is why chemical methods barrier contraception- spermicides - are successfully used in adolescence, because those of them, which include benzalkonium chloride, are only contraindicated in the presence of vaginitis or individual intolerance to the active substance. Of course, spermicides require especially careful following of the instructions for use, it is the violation of the rules that is the reason unwanted pregnancy. But women of this age, as a rule, are attentive and accurate, and couples are not as hasty as in their youth, so the risk of getting pregnant is minimized (Pearl index - an indicator of the reliability of the method, determined by the number of failures per 100 women when used during the year - with proper use of spermicides, does not exceed 1).

Spermicides are useful as a safety net when using a condom or diaphragm, when you skip or miss hormonal birth control pills, and are also very good as a lubricant. During the period of perimenopause (1 year before and 1 year after the cessation of menstruation), vaginal dryness often occurs, and in this case, suppositories and cream recommended for reduced vaginal secretion help solve another problem of transitional age.

Many women have felt for themselves that the changes that occur in the body during the perimenopausal period lead to an imbalance in the microflora of the vagina, so a fair question arises whether the spermicide introduced into the vagina will affect the spermicide contained there. beneficial bacteria Will it upset an already fragile balance? But as numerous studies have shown, modern facilities contraceptives have a positive effect on the vaginal biocenosis and local defense mechanisms. Spermicides are a universal contraceptive in the sense that they can be used at any time in a woman's life, and have official testimony for use during perimenopause.

The choice of contraception after the age of 45 years, that is, in the so-called "transitional" period, is often a very difficult task due to the peculiarities of this age period, associated with the inevitable processes of gradual fading of ovarian function, the presence of a number of gynecological and extragenital diseases, the appearance of hetovascular and other early symptoms of menopause.

Despite the fact that fertility decreases in this age period, cases of childbirth in women over 45 years of age are not so rare. According to Western European statistics, up to 30% of women aged 45-54 have a regular menstrual cycle and are fertile. At the same time, against the background of a regular rhythm of menstruation, the frequency of ovulatory cycles reaches 70-95%, and with oligomenorrhea - up to 34%. By this age, most women have already decided on the number of children in the family; situations such as remarriage, accidents with children and the need for childbirth are rare. In most cases, when pregnancy occurs, the question of induced abortion arises.

Abortions in perimenopausal women are much more likely to be accompanied by various complications; the frequency of complications is 2-3 times higher than that in women of reproductive age. Often after an abortion, inflammatory diseases of the genital organs, complications associated with the presence of uterine fibroids, endometriosis, and exacerbation of extragenital pathology occur. It has been proven that an abortion performed in the "transitional" period often entails a severe course of the climacteric syndrome and is a background for the development of hyperplastic processes in the target organs - the uterus and mammary glands.

This age period is characterized by:

Relatively high fertility;

decline sexual activity, predominantly one sexual partner;

Reducing the risk of contracting STIs and AIDS;

Implemented reproductive plans;

An increase in the number of extragenital pathology, limiting the choice of contraceptive method;

An increase in the number of gynecological diseases.

When choosing a method of contraception in this age period, in addition to reliable prevention abortion, the question arises of how to avoid influencing metabolic processes who have undergone (or are undergoing) age-related changes against the background of high sensitivity the female body to exogenous influences. Prevention and treatment of the initial symptoms of menopausal syndrome and, if possible, slowing down the aging process is another of the main tasks of using certain contraceptives in this age period.

The main requirements for contraception are: reliability, healing effect, minimal risk of metabolic disorders, prevention and treatment of initial symptoms of menopausal syndrome.

Undoubtedly, the most promising in this respect hormonal contraceptives, but before the advent of modern hormonal agents (microdosed drugs and releasing systems), this was hardly feasible.

Recent studies have shown that modern micro-dosed COCs latest generation have no or minimal metabolic effect on female body. In view of this, they can be used by non-smoking women after 40 years of age in the absence of risk factors associated with hypercoagulability (WHO, 1998). Such risk factors in the use of any type of hormonal contraception include primarily cardiovascular disease, liver disease, heavy smoking in combination with the use of COCs.

In the absence of contraindications, microdose preparations (Mersilon, Logest, Novinet, Lindinet, skin patch, NovaRing vaginal ring, etc.) can be used quite widely.

The advantage of microdosed drugs is a protective effect in the symptoms of menopausal syndrome, which are quickly stopped. Estrogen-gestagenic contraceptives have a very positive effect on bone tissue: they stimulate specific osteoblast receptors, block glucocorticoid receptors, and have an antiresorptive effect. According to various authors, the incidence of osteoporosis in women who used hormonal contraception during the period of perimenopause is 3 times lower than in those who did not use it, and therefore, the frequency of fractures is also lower. Before prescribing COCs, risk factors should be considered individually and the acceptability of the method should be assessed (see Appendix 2).

Progestin preparations (mini-pills, Charosetta, Depo-Pro-vera, Mirena system) do not contain an estrogen component and therefore have little effect on the blood coagulation system, lipid metabolism and liver function. Their use is highly justified in hyperplastic processes of the endometrium, uterine myoma. The disadvantage of progestin contraceptives is that menopause and atrophic changes may occur earlier, and vegetovascular changes are not stopped.

As for the possibility of using intrauterine contraception, in the absence of all these contraindications, it can be used up to menopause. In this case, preference should be given to IUDs with a large copper area (T Cu-380, Multiload-375, etc.) and the Mirena hormone-producing system, which is also successfully used in postmenopause as a progestogen component hormone replacement therapy. Pain and infection with IUD use in perimenopausal women is less common than in younger women. However, IUD use is limited by dysfunctional uterine bleeding often occurring in perimenopause.

Mirena is suitable for women of this age group, as it is a long-acting and convenient method of contraception and provides a therapeutic effect in hyperplastic processes in the endometrium, menorrhagia and endometriosis.

The results of a study conducted at the Scientific Center for Anti-Aging and Practitioners of the Russian Academy of Medical Sciences, in addition to high contraceptive efficacy, revealed therapeutic effect Mirenas in patients with symptoms of primary dysmenorrhea and premenstrual syndrome. In 20% of women with primary dysmenorrhea after 5-6 months. the use of Mirena noted the disappearance or significant weakening of pain.

In addition, 21.5% of women with premenstrual syndrome there was a significant improvement general condition already 5-6 months. the use of Mirena, which was expressed in the disappearance of symptoms such as irritability, weakness, bloating, decreased ability to work and swelling lower extremities(Prilepskaya V.N., Tagieva A.V., 2000).

Many women in this age period use barrier methods of contraception. Given the age-related decline in fertility and less frequent sexual intercourse, they can be successfully used by married couples who consider them suitable for themselves, especially in the presence of gynecological and extragenital pathologies in women who do not allow the use of other methods of contraception.

Barrier Methods contraception require correct application, high motivation of behavior, which is usually found in women of this age. These methods protect against STIs, and some chemical spermicides, such as creams with nonoxynol, help eliminate vaginal dryness, which is often observed in women in menopause.

Natural methods of contraception are also very popular among women over 45 years old.

In the first place among them is the method of coitus interruptus, since it does not require the use of other contraceptives, planning of sexual intercourse. However, its effectiveness is low, and for some men it is completely unacceptable.

With periodic abstinence, several methods are used to determine the so-called "fertile" phase of the cycle: measurement basal body temperature, examination of cervical mucus, calendar method, symptothermal method. The advantage of intermittent abstinence is its safety and lack of side effects. However, it should be remembered that during the premenopausal period it is difficult to determine the time of ovulation due to the high frequency anovulatory cycles therefore, intermittent abstinence should be offered as an alternative method to those couples who do not want to use other, more effective methods contraception for any reason (fear of side effects, religious restrictions, etc.).

According to the WHO (1994), contraception is recommended for women even after menopause. If menopause occurs before the age of 50, contraception is required for two years after the last menstrual period; if menopause occurred after the age of 50, then within one year. Women with premature menopause (onset before the age of 40) are shown low-dose COCs, the use of which is possible until the age of natural menopause (if there are no medical contraindications).

A special group of patients are women aged 40-50 who take hormonal contraceptives. Such patients have monthly regular menstrual-like bleeding on drug withdrawal. Therefore, it is difficult to assess the function of the ovaries and the period in which the woman is (premenopause, menopause). In such cases, the hormonal contraceptive should be canceled and after 6-8 weeks. after cancellation twice with an interval of 4-6 weeks. determine the level of FS G and L G.

Further tactics are determined according to the level of hormones:

1. If the level of FSH is more than 30 IU / l, and the woman does not have a period during this period, then this indicates that the woman is in menopause.

2. If the FSH level is normal, regardless of the presence or absence of spontaneous bleeding, then the patient is in perimenopause and is potentially fertile and needs further contraception.

Thus, at present, there are possibilities for the use of various methods of contraception from adolescence before menopause and within 1 year after it, not only to prevent unplanned pregnancy, but also to maintain reproductive health.

Contrary to popular belief, you still need to use contraceptives before and sometimes after menopause. Many women start looking towards birth control pills after the age of 45 because of their convenience. They do not reduce sensitivity during intercourse, like condoms, they do not threaten the danger of inflammation, like.

However, it must be remembered that the time before menopause is delicate from an endocrinological point of view. Which pills to choose - this should be decided only by the doctor. After all, the side effects of taking hormonal pills can be unexpected and very unpleasant.

It is important to consider age when planning fertilization and pregnancy. In the opposite case, when pregnancy is undesirable, it is just as important. Women's fertility declines by the age of thirty-five. This is due to a decrease in estrogen levels and other endocrine changes. Becomes less stable menstruation and ovulation.

Reproduction stops on average by the age of 50, when menopause (menopause) occurs.

But as long as the menstrual cycle continues, do not think that age will be a sufficient guarantee of the absence of conception. The problem of contraception should be raised until the menopause is over. Yes, and eggs can still be stored in the ovaries even after fifty. Therefore, one way or another, think about contraceptives have to. The question arises which method will be ideal.

Of course, pills are not the only contraceptive method. However, according to many women and doctors, it is better than other methods:

• Condoms reduce sensitivity, especially from a male point of view. And since we usually choose partners among peers, we must remember that after 40 years, many men have reduced potency. Many even have problems with potency as such. And here condoms interfere not only with getting the maximum pleasure from sex, but generally deprive the couple of such an opportunity;
• Intrauterine contraceptives may be contraindicated due to the fact that women at this age often have already experienced gynecological inflammation or increased risk. yes and availability foreign body causes psychological discomfort in the body;
• Spermicidal agents in the form of suppositories or ointments are not always convenient to use, and do not have a very high reliability.

Why you need to keep protecting yourself

If fertilization occurs at this age, the consequences may not be the most pleasant. Of course, if a woman has delayed the birth of a child to 45, she still wants to give birth - this is often still possible, but preparation for conception and pregnancy should be under the strictest medical supervision.

Pregnancy at the age of 45 for women is fraught with health problems.

Difficulties may arise in the functioning of the liver, urological system, heart and blood vessels. Specific manifestations of pregnancy and problems with gynecological organs may also get worse. In addition, the condition of the fetus also causes concern in a woman. By this age, a woman dramatically increases the possibility of genetic mutations and gestation problems.

Since the likelihood of conception before menopause is already greatly reduced, many women decide to give up contraception. Women hope that if unwanted fertilization occurs, then it will be possible to have an abortion without any special consequences. After all, the fear of losing fertility in most cases is no longer justified by the age of 45.

The most popular birth control pills are COCs. They include estrogen (the female sex hormone) and progesterone-like substances. They can be divided into the following groups depending on the content of active ingredients in each tablet:

• Taken in one phase (Yarina, Logest) - each tablet has the same percentage of hormones;
• Taken in two phases (Anteovin) - the use is divided into two periods, during which the percentage of progestogen is replaced, and the female sex hormone does not undergo changes;
• Taken in three phases (Trikvilar, 3-merci) - these tablets vary the percentage of estrogens and progestogens.

The selection of the ideal combined contraceptive is carried out by the attending gynecologist. It takes into account both age and individual indicators health.

How cooks work

Combined oral contraceptives manifest themselves as follows:

• Ovulation is suppressed. Due to the increased level does not leave the ovary;
• Gestagen increases uterine mucous secretions. Because of this, male germ cells cannot penetrate the uterus and fallopian tubes;
• A substance similar to progesterone makes the uterine tissues denser. A fertilized female cell will not be able to penetrate into them.

These factors together reduce the possibility of conception to a minimum. In addition, after 45 years, closer to menopause, such pills will change the hormonal background in a positive direction.

Contraindications

These tablets should not be taken if the woman:

• Pregnant (here you need to remember that such pills are prescribed not only for contraception);
• Suffering from cardiovascular pathologies;
• experiencing increased performance blood clotting;
• Smokes after 45 years;
• Suffering from kidney failure;
• Treated for malignant tumors;
• Breastfeeds the baby.

If in these situations a woman after 45 still decides to use COCs, the likelihood of side effects increases:

• Thromboembolism, the occurrence of blood clots;
• Liver disease;
• Sudden mood swings, depression;
• A set of excess mass;
• Violations of the digestive tract;
• Dermatological diseases;
• Hearing impairment;
• Diabetes.

How to use

COCs are known for being required to be taken according to a regimen. In most cases, a woman uses contraceptives for three weeks, and then takes a break - during menstruation. In some cases, when COCs are used as gynecological drugs, they must be taken without interruption.

If the use has been missed, manufacturers and doctors give the following recommendations:

• When less than 12 hours have passed after the missed dose, you need to remember this, take a pill, and then continue to drink according to the old scheme;
• If 12 hours have already passed, we use the remedy, but before menstruation we use condoms if necessary. If at the same time less than a week is left before the break, we immediately begin to take another package without interruption.

After 45 years, taking COCs, you must definitely check with your doctor. This should be done at least once every 12 weeks.

Single component hormonal contraceptives

Such tablets contain only a gestagen. Their other popular name is mini-pills. These tablets include Microlut, Charozetta.

In them, the main active ingredient is artificial substances similar to progesterone. Such contraceptives suppress the possibility of conception, but have less reliability and side effects caused by estrogen. In the case of a woman after 45, only the attending gynecologist can decide which is better.

How do they work

Contraceptives based only on progesterone work as follows:

• Increase the amount of mucous secretions in the uterine region;
• Reduce the thickness of uterine tissues;
• Do not allow ovulation to occur;
• Reduce the peristalsis of the fallopian tubes.

The woman is protected at all levels. And if conception did occur, the egg will not be able to attach to the uterus due to changes in its tissues.

Cons and pros

Why use progesterone pills if estrogen contraceptives are already effective? The fact is that KOC has much more contraindications. And single-component tablets can also be used in cases where a woman:

• Smokes after 45 years;
• Breastfeed;
• Suffers from diabetes;
• Suffering from high blood pressure;
• Does not tolerate external estrogen.

In the case of mammological tumors and pregnancy, progesterone must also be abandoned.

However, there are also some contraindications, including:

• Liver disease;
• causeless bloody issues from the vagina;
• A previous pregnancy outside the uterus;
• The need to take muscle relaxants.

Which pills to use for a woman after 45 years - single-component or combined, the doctor will decide. It depends on hormonal background women. By the age of 45, it can undergo changes, and sometimes extra estrogen is beneficial, and sometimes not.

Microdosed

These include Jess, Dima, Logest. They contain a minimum of hormonal substances in order to prevent side effects. May be required after 45, if you need not to increase, but to minimize the endocrine effect. If such funds led to bleeding during the period of use, it is worth abandoning them and replacing them with low-dose tablets. These birth control pills have a higher percentage of progesterone as opposed to estrogen. When taking such funds, it should be remembered that contraindications for combined oral contraceptives. Although the side effects are minimal compared to them.

For citation: Prilepskaya V.N., Nazarova N.M. CONTRACEPTION IN WOMEN OF TRANSITION // BC. 1998. No. 5. S. 9

Menopause at modern woman occurs at the age of 45 - 55 years. It has been proven that follicles with eggs remain in the ovaries for 3-5 years, which explains the cases of pregnancy after the cessation of menstruation. According to WHO recommendations, contraception is recommended for women up to menopause and the absence of menstruation for 1 year.

In women of this age, promising is progestogen contraception (mini-drank, injectable, norplant). Surgical contraception could be the method of choice for women of transitional age who have decided the issue of the number of children in the family.

Barrier methods of contraception, due to the decrease in fertility during adolescence, can be successfully used by couples who consider such methods acceptable.

The menopause in today`s women occurs at the age of 45 - 55 years. There is evidence that ovarian follicles and ova remain during 3 - 5 years, which is attributable to some cases of pregnancy after cessation of menstrual bleeding.

According to the WHO recommendations, women should use contraception right up till the menopause and in the absence of menstrual bleeding for 1 year. For women of this age, gestagenic contraception (minipills, injections, norplant) is promising. Surgical contraception could be the method of choice for women in the transitional period who would solve how many children they could have.

Due to reduced fertility in the transitional period, barrier contraception can be successfully used by a married couple who considers it to be acceptable.

V.N. Prilepskaya - prof., MD, head of the outpatient department, N.M. Nazarova - scientific. co-worker, Ph.D. Science Center Obstetrics, Gynecology and Perinatology (Director - Academician of the Russian Academy of Medical Sciences Prof. V.I. Kulakov), Russian Academy of Medical Sciences, Moscow
Prof. V.N. Prilepskaya, Dr. Sci., Head of Outpatient Department, N.M. Nazarova, Candidate of Medical Sciences, Researcher, Research Center of Obstetrics, Gynecology, and Perinatology, (Director Prof.V.I.Kulakov, Academician of the Russian Academy of Medical Sciences), Russian Academy of Medical Sciences

R The reproductive health of middle-aged and older women is given great attention in many countries of the world. To a certain extent, this is due to the fact that it is this contingent of women that makes up a significant proportion of the economically, culturally and socially active population. Undoubtedly, the reproductive health of women in these age groups is influenced by many factors, such as living conditions, work, reproductive history, exposure to infectious, chemical and other influences, the availability of qualified medical care and others. Certain conditions associated with age, menopause and other problems of aging of the body also affect their health. The main difficulties in addressing the issue of contraceptive methods in women of transitional age are associated with a number of features that characterize this period of a woman's life.
Age-related decline in fertility is a generally accepted fact, but it still remains controversial issue about the start of this decline. Literature data indicate for the absence (with a regular menstrual cycle) of significant differences in FSH levels, LH, estriol and progesterone between women with normal weight body after the age of 45 and 18 - 30 years.
Yes, late reproductive age frequency of ovulatory cycles at regular rhythm menstruation is 95% and even with physiological oligomenorrhea - 34%.
Thus, there is no doubt that the so-called perimenopausal conception potential can be preserved. Therefore, the problem of reliable and safe contraception during this period of a woman's life remains relevant (WHO, 1994).
In view of the fact that by the age of 40 most women have already resolved the issues of family planning and the number of children in the family, the onset of an unplanned pregnancy extremely often ends in an induced abortion.
Almost half of all pregnancies that occur in women over the age of 40-45 years are completed by abortion, and very often it is complicated by inflammatory diseases of the genital organs, the development of uterine fibroids,endometriosis, a severe course of the menopause and, most dangerously, in the future it is the background for the development of oncological pathology in target organs: the uterus and mammary glands.
Despite the fact that in this period of a woman's life there is an age-related decline in fertility, cases of children being born over the age of 45 and even after 50 are not so rare. Many women, even in their 50s and older, continue to have regular periods with a certain number of ovulatory cycles. Thus, according to the statistics of Western European countries, 50% of women aged 44 and 30% aged 45-54 are sexually active, have a preserved menstrual cycle and are fertile, and therefore need contraception until menopause (WHO, 1994).
Thus, there is no doubt that the main purpose of contraception in this contingent of women is to prevent abortion and its detrimental consequences.
There is currently an increasing number of women who, due to certain life circumstances and reasons, they plan the birth of a subsequent, and often the first child after 40 - 45 years. Pregnancy in such cases is accompanied by high risk miscarriage, a high frequency of gestosis, abnormal location of the placenta, extremely a large number complications during childbirth and in the postpartum period, high childhood morbidity and mortality. This risk is 20 times or more higher than in women in the early reproductive period.
It has been proven that the health of women after 40-45 years is largely impaired. Pregnancy and childbirth occur against the background of extragenital pathology, which is recorded in 60% of cases, and in 2/3 of the patients it is chronic.
Most often these are cardiovascular diseases, diseases of the urinary system, liver, digestive organs, etc. As for gynecological morbidity, it is quite high and ranges from 44 to 65%. Among gynecological diseases, chronic inflammatory processes of the genital organs, uterine fibroids, disorders menstrual cycle, prolapse of the uterus and vagina, etc. In addition, 10% of women of this age have previously undergone surgery on the genitals.

What methods of contraception can a woman use in this period?
Intrauterine contraception (IUD) occupies one of the leading places in terms of prevalence among the effective and acceptable methods of contraception used. Intrauterine contraceptives are highly effective, do not have a systemic effect on the body, are affordable, cost-effective, can be used for a long time, while the restoration of fertility after removal of the intrauterine device (IUD) occurs very quickly.
As for women aged 45 and older, IUD is often contraindicated for them due to pathological changes in the cervix and / or body of the uterus, the presence of endometrial hyperplastic processes, uterine fibroids large sizes etc. However, it can also be applied, taking into account generally accepted absolute contraindications(WHO, 1995) which include: malignant lesions of organs reproductive system, conditions after abortion or childbirth complicated by sepsis, inflammatory diseases of the genital organs, transferred 3 months before the introduction of the IUD, anomalies in the development of the uterus, tuberculosis of the genital organs.
Preference should be given to hormone-producing IUDs of the Levonova type (Finland), which help to reduce the volume menstrual blood, prevention inflammatory diseases genitals. Such naval forces as SIT-380 (Germany), Multiload-375 (Netherlands) can also be successfully used, i.e. copper-containing IUDs in which the copper surface area exceeds 300 mm.
Hormonal contraception characterized high efficiency, pronounced medicinal properties in a number of gynecological diseases: endometriosis, uterine myoma, hyperplastic processes of the endometrium and mammary glands. Patients using hormonal contraceptives are less likely to develop osteoporosis in postmenopause, the incidence of ovarian and uterine cancer.
According to WHO recommendations (1995), hormonal contraceptives are absolutely contraindicated in pregnant women, intensively smoking women, women with existing and past history of thromboembolic complications, with diseases of the cardiovascular system, severe diabetes mellitus, severe liver disease, malignant neoplasms organs of the reproductive system.
It is known that hormonal contraception with estrogen-progestin preparations is potentially associated with an increased risk of vascular and thromboembolic complications in women of transitional age, even when it comes to low-dose drugs of the latest generation.
Thus, in women 45 years of age and older, it is very promising progestogen contraception (mini-drank, injectable, norplant). These drugs do not contain an estrogen component and therefore do not cause pronounced changes coagulation factors, lipid metabolism, do not adversely affect liver function.
From injectable progestin The best known drug is Depo-provera-150 (DMPA), which has benefits unrelated to its contraceptive effect - reduces the risk of inflammatory diseases of the genitals, cases of vulvovaginal candidiasis, does not adversely affect liver function, gastrointestinal tract thereby reducing the likelihood of metabolic changes. It has been established that Depo-Provera does not cause pronounced changes in blood coagulation factors, lipid metabolism, which determines its advantages over oral contraceptives in terms of the risk of cardiovascular disorders in women over 40.
Studies by V. N. Prilepskaya and T. T. Tagiyeva showed that, taking into account the high contraceptive efficacy and the peculiarities of the effect of DMPA on hormone-dependent organs, its use in women of late reproductive and older age is justified, especially in the presence of endometrial hyperplastic processes, uterine fibroids , endometriosis. Most women with endometrial hyperplastic processes have their partial or complete regression.
Norplant - subcutaneous implant It is also an effective long-acting contraceptive. Six small Silastic softgels containing levonorgestrel are implanted under the skin of the upper arm through a small incision under local anesthesia. The contraceptive effect is provided due to the slow continuous release of levonorgestrel into the bloodstream and manifests itself within a day after the administration of the drug, remaining for 5 years.
When using prolonged-acting progestogens, a delayed restoration of fertility is observed - ovarian function may not be restored for a long time (up to two years or more), and in a number of patients over the age of 45, fertility may not be restored and menopause occurs.
Currently surgical contraception is the most widely used method. Distinguish between male and female sterilization.
Sterilization of women is a surgical operation in which the patency of the fallopian tubes is disrupted, as a result of which fertilization becomes impossible.
There is no doubt that surgical sterilization could be the method of choice for women aged 45 and older who have decided on the number of children in the family. It is especially indicated for women with various extragenital and gynecological diseases, for whom pregnancy is contraindicated due to their state of health. It should be emphasized that for women with increased risk unwanted pregnancy, there are no absolute contraindications to sterilization (WHO, 1994).
From all patients applying for voluntary surgical sterilization, written consent must be obtained in order to document the existence of an informed and voluntary choice, and to give the transaction legal legitimacy.
male sterilization(vasectomy) is a highly effective method that stops a man's fertility without changing hormonal, sexual functions, potency, does not affect the process of seed formation, i.e. men's sexual functions remain unchanged.
However, in our country, due to the traditional attitude towards surgical intervention as a very complex procedure, surgical contraception has not yet found proper application. In addition, many clinics do not have the appropriate equipment to perform a sparing operation by laparoscopy.
Barrier Methods contraceptives have a low contraceptive efficacy, but they certainly have an advantage in the prevention of sexually transmitted diseases (STDs). However, due to a decrease in fertility during adolescence, they can be successfully used in married couples who consider such means suitable, especially in the presence of extragenital pathology and gynecological diseases that do not allow the use of other methods of contraception.
Barrier methods are divided into mechanical (preventing the advancement of spermatozoa - condom, caps) and chemical (affecting spermatozoa, destroying their membrane and reducing their mobility - nonoxynol, benzalkonium chloride).
Barrier methods of contraception require the correct use and high motivation that women of this age usually have, protect against STDs, and some chemical spermicides, such as creams with nonoxynol, help eliminate vaginal dryness, which is observed in a number of women in menopause. However, the use of the drug "Pharmatex" can cause a burning sensation in the vagina in some women.
A popular method of barrier contraception is the condom. Its use is indicated in all age periods, including older couples. In terms of effectiveness, the condom is inferior to modern methods of contraception and its use is directly related to sexual intercourse, which is not always acceptable for married couple. However, for some couples, it is the most acceptable, especially during sexual life in a long marriage.
Emergency or postcoital contraception occupies a very important place in the problem of contraception, but in women aged 45 years and older, its use is highly undesirable due to the use large doses hormones that can adverse effect on the body.
Emergency contraception as an emergency measure of protection against pregnancy should be recommended to women who have been raped, or if there is doubt about the integrity of the used condom, under strict medical supervision.
The most common means emergency contraception are combined estrogen-gestagen preparations. Assign 200 mcg of ethinyl-estradiol and 1 mg of levonorgestrel for following scheme: within 72 hours after the act, the woman takes the first half of the dose, and after 12 hours - the second.
It should be emphasized once again that postcoital contraception is a one-time contraception and its use in women of any age should be carried out according to strict indications and only under medical supervision.
Natural methods of contraception are also very popular among women 45 years and older.
On the first place among them is the method coitus interruptus, and this is understandable, since it does not require the use of other contraceptives, planning sexual intercourse. However, its effectiveness is low, and for some men it is completely unacceptable.
For couples who can put up with the restriction of sexual life or who rarely have sex, it is also suitable periodic abstinence However, this method is unacceptable for women with irregular menstrual cycles, i.e., with oligomenorrhea, which is observed in a number of premenopausal women.
With periodic abstinence, several methods are used to determine the so-called fertile phase of the cycle: measurement of basal temperature, examination of cervical mucus, calendar method, sympto-thermal method. The advantage of periodic abstinence is its safety and the absence of side effects. However, the effectiveness of the method depends on strict adherence to the rules for its use.
It should be emphasized that intermittent abstinence should be offered as an alternative method to those couples who do not want to use other, more effective methods of contraception for any reason (fear of side effects, religious or cult restrictions).
It should be emphasized that the reproductive health of women of transitional age depends, in particular, on the successful use of contraception. When choosing a method of contraception, it is necessary to take into account the state and characteristics of the body during this period of life, the acceptability of a particular method for a married couple.
Medical advice should include individual approach for each patient, a detailed explanation of the advantages and disadvantages of a particular method. Only such a differentiated approach can provide reliable, convenient and even comfortable protection against an unplanned pregnancy and its consequences.

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