CONTRACEPTIVE CARE OF THE OLDER PATIENT – WORRY REGARDING PREGNANCY (AVOIDING PREGNANCY)
New-found independence, which often comes when there has been a final acceptance that the child-bearing days are over, provides freedom to enjoy life as a couple again. In the same way a new job or entry into training for a new career makes the need to avoid pregnancy or prime importance, so couples may need to reconsider their contraceptive method.
At this stage in life a late period can be a cause of great alarm. Pregnancy must be excluded, for an assumption that the patient is menopausal is unhelpful and may give a sense of false security which is disastrously dispelled if a pregnancy is later confirmed. If the woman has been using the rhythm method or the safe period, with or without the intermittent use of a barrier method, explanation is necessary: now that she is peri-menopausal she cannot rely on the safe period as her menstrual cycle will be irregular. Women who have continued to use natural family planning or a combination of those methods with a barrier method may need a lot of education and support, as well as an examination of their fears if they are to be helped to use a safer method such as the IUCD or hormonal contraception. The fact that they have not chosen those methods before may tell doctors something about their feelings towards them.
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