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Contraception in your 40s and addressing post-coital issues

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If you are over the age of 35 and you smoke, have high blood pressure or high cardiovascular risk then you may not be prescribed the combined contraceptive pill

If you are over the age of 35 and you smoke, have high blood pressure or high cardiovascular risk then you may not be prescribed the combined contraceptive pill

Getty Images/Science Photo Libra

If you are over the age of 35 and you smoke, have high blood pressure or high cardiovascular risk then you may not be prescribed the combined contraceptive pill

I'm approaching my 40th birthday. I've been using the pill as a method of contraceptive since my 20s. I've been told it can be dangerous in those ever 40. Is this true?

DR BYRNES: There are many different methods of contraception available so choosing the right one for you is very important.

Most methods of contraception can be used up to 50 and beyond. There are a few things to consider when choosing a contraceptive in your 40s.

If you are over the age of 35 and you smoke, have high blood pressure or high cardiovascular risk then you may not be prescribed the combined contraceptive pill, patch or vaginal ring.

This contains oestrogen which does slightly increase the risk of heart attack and stroke. If you do not fall into the risk above you can safely take the combined pill up to the age of 50 and there is no reason to change.

If oestrogen isn't an option then a progesterone-only method is an option.The progesterone-only pill must be taken daily. The depot injection is given every 12 weeks.

The contraceptive implant is about the size of a hair pin and is placed under the skin of the arm. It can stay in place for up to three years. The intrauterine system is a progesterone-coated coil which is placed in the womb. This can stay in place between three and five years.

If you want to avoid hormones altogether options include using condoms, a copper coil, vasectomy or female sterilisation.

If your family is complete one of the longer-acting or irreversible options may suit you better. Male vasectomy is now also a much more straightforward procedure than it used to be.

It is important to have your body mass index measured before deciding which method you choose. Some methods are less effective or need to be changed at a short interval in those whose BMI is higher than 35.

Consider your menstrual cycle when choosing. Methods which contain oestrogen tend to give a regular predictable menstrual cycle. In those choosing progesterone-only methods menstruation may be absent, or irregular.

Menstruation tends to get heavier in those who have a copper coil in situ or who undergo female sterilisation.

Contraceptive choice is important.Talk to your GP to decide which method is best for you.

 

I have an embarrassing problem. I get terrible headaches whenever I have sex. They can last for up to 24 hours and I feel almost hungover. It's causing stress in my marriage as I've started avoiding sex and my wife isn't very happy.

DR BYRNES: Post-coital headaches are thought to occur in about 1pc of the population. They are more common in men. Those who are middle-aged, overweight and unfit are at risk.

Early coital cephalgia is a tight dull cramping pain that may occur prior to orgasm. It builds up during sexual activity, can be severe but usually only lasts a few minutes.

The second type of headache is called orgasmic coital cephalgia. This pain comes on very suddenly and is severe. It may occur at the back of the head or behind the eyes and occurs at the point of orgasm.

The third kind of headache is called late coital cephalgia. It may occur hours after intercourse and can go on for hours and even days.

Orgasmic coital cephalgia can mimic the headache caused by a bleed in the brain and this may need to be ruled out. It is worthwhile having a brain scan arranged. Once any abnormality has been ruled out treatment needs to be considered.

Propranolol is a medicine that was initially designed to control blood pressure but can be effective for post-coital headache. Unfortunately a side effect of this medicine can be erectile problems which may preclude its use.

Indomethacin is an anti-inflammatory medicine that has shown some benefit. It needs to be taken about 30 minutes before intercourse for its maximum benefit. Altering sexual positions and taking a more passive role in intercourse can also help in some people.

It is important to talk about this as its impact on intimate relationships should not be underestimated.

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