Health News and Information

So far we have described a pretty unpleasant series of events, and younger women will be reading this with a sense of dread at the thought of their menopause approaching. It is not always so bad and, as we have already said, up to 25 per cent of women don’t have significant problems. Others may have symptoms, but they are short-lived, and the women are prepared to put up with them. The rest may have some or all of the symptoms we have described, to varying degrees, and may or may not seek help for them.

Diagnosing peri-menopause is not usually that difficult, as it only happens to women, and usually women of a certain age group. It can be tricky if it happens to younger women, as it occasionally does (and it is called premature menopause if it happens before the age of 40). It can also be confusing as some of the symptoms described could occur in other conditions, such as thyroid disease for example.

There are specific tests which can be used to confirm that the ovaries are becoming resistant to the messages from the brain, which is the key effect in menopause. The level of the specific hormone (FSH, follicle stimulating hormone) in the blood stream is increased. When the ovaries don’t respond to it by making an egg, it begins to increase in concentration, as though it is raising its voice, and shouting at the ovaries ‘Make an egg!’.

Samples of cells scraped from the vaginal wall and cervix (in the same way as a pap smear) will show changes of decreased oestrogen after the menopause. Blood tests are usually unnecessary to determine if a woman is menopausal, but they may be useful in some circumstances.

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For abortions up to 12 weeks of pregnancy the procedure is usually done with a local anaesthetic in a clinic or hospital. There is less risk with a local anaesthetic and you will recover more quickly, but if you prefer a general anaesthetic, it may be possible. Some clinics have another type of anaesthetic, which is given intravenously. It is called light sedation or ‘twilight sleep’. While this type of sedation does not put you completely to sleep most women remember very little about the abortion when they wake up. You can ask about this as well when you first talk to your doctor or a counsellor about abortion.

When you go to the clinic or hospital, you may be given some medication to relax you before the procedure. The doctor performing the abortion will give you a pelvic exam and put a speculum in your vagina. A speculum is a type of instrument that can be slowly opened in your vagina to hold the vaginal walls apart so that the doctor can see your cervix easily.

If you are having a local anaesthetic, it is given into your cervix, and although some women find it a bit uncomfortable, others are not bothered by it at all. If you are having a general anaesthetic or sedation, this is usually given before the speculum is inserted into your vagina.

When the cervix is numb, the opening is slowly stretched to allow a narrow plastic tube to go through into the uterus. The tube is attached to a machine that uses gentle suction to remove the contents of the uterus. This all takes about 10 to 15 minutes. When the procedure is finished you will need to rest for a while before leaving so that the doctor can be sure you are recovering as expected. If you have asked to have sedation you may be asked to wait a little longer in the clinic until you wake up completely and you won’t be allowed to drive yourself home.

After 12 weeks of pregnancy, some abortions are still done in clinics but many are done in a public or private hospital. Up to 20 weeks of pregnancy many doctors will use a method which uses little sticks of dried seaweed which are put into the cervix (opening of the uterus) a day before the operation and gradually swell up so that they slowly expand the opening. This can make some women feel crampy and nauseated but usually means that the doctor can use a slightly larger suction tube to remove the foetus from inside the uterus the following day, without too much discomfort.

Another method is to inject hormones and saline into the uterus to make it contract. As it contracts it eventually pushes the foetus out It can take between 12 and 36 hours for the abortion to be completed and the contractions may feel like labour pains. After a later abortion it may be necessary to have another procedure to make sure any tissue that may have been left in the uterus is removed.

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Things to think about if you are considering using breastfeeding as your method of contraception

• After your baby is born, you will ovulate before you have your first period.

• If you are fully breastfeeding, you may not have a period until you start giving the baby extra bottles of milk or formula, or solid food. You may not have a period until you stop breastfeeding altogether. On the other hand, be aware that your periods can start at any time. Everyone is different.

• It is a good idea to start using some other method as well as breastfeeding, from six months after the baby is born. Barrier methods, the minipill, a progestogen-only implant or an IUD are all good methods to think about because none of them will affect your ability to continue breastfeeding. You cannot use a combined pill while you are breastfeeding since it will tend to reduce your milk supply.

• Even if you decide not to rely on breastfeeding for contraception, remember that breastfeeding is good for babies. It is also a convenient feeding method if you have enough milk for your baby and you can organize your life so that you can be available to breastfeed. Breast milk provides a good balance of nutrients for young babies and it gives them greater protection from infection than formula or cow’s milk.

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There is a relatively new way of using hormonal contraception which comes in the form of a contraceptive implant. As you can imagine, an implant is meant to be a fairly long-term method of contraception so some women will find it a great alternative to other methods.

A contraceptive implant is a little plastic rod, or set of rods, containing hormones that are inserted just underneath the skin, usually on the inside of the upper arm. The hormones are released into your body over a period of time and prevent you from becoming pregnant.

Are there different types of implants? The only implant available in Australia at present is called Implanon. It is a small, single, flexible plastic rod, about 4cm long and only 2mm thick. It contains only one type of hormone, progestogen, inside a special coating that stops the hormone being released all at once. The progestogen is slowly released into the woman’s body over a period of about three years.

Other types of implants, like the six-rod implant Norplant have been trialled in Australia and may be available in other countries, but they are not available here at present.

How does an implant work? All implants make the mucus in the cervix thicker so that sperm cannot get through into the uterus and up into the Fallopian tubes to fertilize an egg. They also cause changes in the lining of the uterus so that even if an egg were fertilised it could not implant and grow there. As well, the progrestogen in Implanon also stops the ovaries from releasing an egg each month, making it more effective than some of the implants used in the past.

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The health practitioner who fits the cap may ask you to make two appointments. The first visit is to find out what size you need and how to use the cap, and the second is to check that you are using it properly and that you are happy with it.

You can have a fitting for a cap at any time, as long as you are not pregnant. If you have just had a baby, you should wait at least six weeks after the birth. It is best to wait for a couple of days if you are having a heavy period.

The doctor or nurse will give you an internal examination to check the size and position of your cervix. From that they will have a good idea what type of cap will suit you best and the size that you will need. They may try a couple of different sized caps in your vagina to make sure you are given the exact size. They will show you how to use the cap and will usually give you one to take home and practice with for a week or so. While you are practicing with it, you should use another method of contraception if you have sex. You might want to use condoms, or the Pill or IUD if you already have them.

On your second visit the doctor or nurse will check to make sure you can use the cap properly and that it is a good fit If you decide that you want to keep using a cap, you will then go and buy your own.

You should have the size and fit of your cap checked each time you have a Pap smear.

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