Although fertility diminishes with age, it is not uncommon for pregnancy to occur after 40 years of age. These pregnancies are most often a surprise for the couple. To prevent this delicate situation, it is advisable to use contraceptive methods. A consultation and risk-benefit assessment help to find the best type of contraception for each individual situation.
The classic combined contraceptive pill is not one of the first choices after the age of 40 years, but is not entirely out of the question. It may be prescribed by a specialist, who will evaluate the risks and benefits.
Around the time of the menopause, the coil (IUD) remains a practical and safe method. An intrauterine device containing progestogen hormones may be used to treat irregular bleeding, which is common at this time of life. The use of condomsis, of course, possible.
Tubal sterilisation is final and involves the obliteration of a short segment of each of the two Fallopian tubes. In men, vasectomyis a definitive form of contraception that involves ligature of the vas deferens tubes.
The menopause can have a major impact on personal relations and on sexuality, physically as much as emotionally.
A lowering of oestrogen concentrations has an impact on the vaginal mucous membrane and its lubrication. Vaginal dryness and greater sensitivity to irritation may develop during the menopause and cause pain during sex. This problem is easily resolved by the use of lubricants. Regular sex also reinforces the tone of the vagina.
Some women may feel a reduction of their sexual desire, which partly derives from the lowering of androgens and oestrogens. This link between menopause and reduced libido is not automatic and depends equally on the quality of the couple's relationship. In contrast, it happens that no longer needing contraception can increase libido – a sign that hormones are not the only factors that play a role in sexuality.
Sexual performance and frequency are not an end in themselves. The important thing for a couple is to find a balance without creating too much frustration for one or other of them.
A consultation with a doctor to talk openly about this subject may prove to be useful. It is possible to have a joint consultation with a therapist trained in sexology, or to opt for hormone replacement therapy or other treatments.