Rising heat, restless nights, mood swings: the menopause is an enormous change in the body. “The reason for this change is the finite nature of the fertile phase,” says gynecologist Klaus Doubek, President of the Professional Association of Gynecologists (BVF). But when exactly can you be sure that it’s really over – and that there won’t be an unwanted pregnancy after all?
What actually happens in the body during menopause?
The follicles in the ovaries, one of which has previously matured in each cycle, are used up. As a result, the ovaries almost completely stop producing the female sex hormones. Because they previously influenced many processes in the body, the lack of hormones results in many changes, as Klaus Doubek explains.
The start and duration of menopause are individual. About half of the women have their last menstrual period at the age of almost 52. “Before that, they experience a phase of hormonal change, which becomes noticeable, among other things, through cycle changes – such as a shortening or irregular bleeding lengths,” says Doubek.
By the way: If the last menstruation was at least twelve months ago, this is called menopause.
What are the effects of all these hormonal changes – also on sex life?
In the transition phase, it is the strong fluctuations in hormone production that can cause symptoms. For example, for sleep disorders, thin skin or mood swings. “Increasing estrogen deficiency then leads to further symptoms such as sweating, hot flashes, joint problems, palpitations, dry vagina or problems during sexual intercourse,” says Katrin Schaudig, gynecologist and President of the German Menopause Society.
After all, according to gynecologist Dobek, there is no evidence that sexuality is affected by the hormonal changes of menopause. With one exception: vaginal dryness, which can be quite uncomfortable during sex.
According to the German Menopause Society, however, it can be treated well with creams and gels containing hyaluronic acid. If that is not enough, there are also creams, gels and suppositories based on estrogen. However, they must be prescribed by a doctor.
And what about the libido? “Many women report that the desire for sex is decreasing,” says Schaudig from her practice “Hormone Hamburg”. “But this is by no means the case for all women.” What sex life looks like during menopause is individual: some feel more like sex, others less – and sometimes nothing changes.
How much longer do I have to take contraception?
“As long as egg cells are present, pregnancy can theoretically still occur,” says Schaudig. And if bleeding occurs again after a month-long break? Then, according to Schaudig, that means that an egg cell in the ovary has “awakened from its slumber”. So it can come back to a normal cycle with ovulation.
So as long as bleeding occurs – even if only sporadically – there is no getting around contraception. “There is no (blood) test method to determine whether the woman still needs to use contraception or not,” emphasizes Schaudig. Klaus Doubek gives a rule of thumb for when you can stop: “Contraception is usually no longer necessary if there has been no menstrual bleeding for 12 months.”
What is the probability that I will still get pregnant during menopause?
According to the BVF, the probability of pregnancy between the ages of 45 and 49 is around five percent. From the age of 50 it drops to zero. “Pregnancies at this age and naturally are usually unexpected and undesirable,” says Doubek. “They also harbor a higher risk of disease for mother and child.”
In general, the rate of miscarriages increases with age. Because the egg cells are exactly as old as the women themselves. “This also increases the number of chromosomal changes in the egg cells that lead to miscarriage,” says Schaudig.
These miscarriages usually take place very early and are classified by women as delayed menstrual bleeding. The pregnancy is not even recognized as such. However: “There are therefore no precise statistics on the miscarriage rate at this age,” says Schaudig.
What is the best way to prevent?
This is best discussed with the gynecologist. Many of them have additional training in sexual medicine. “Since the risks of thrombosis and stroke are higher at this age than in young women, taking the classic, combined “birth control pills” is often out of the question,” says Schaudig.
On the other hand, the estrogen-free birth control pill and hormone-containing spirals are almost risk-free. “Both are also helpful in preventing heavy menstrual bleeding, which is common at this stage of life.” Other methods that are well tolerated during menopause are copper coils or chains and the condom.
