A discussion of “safe sex” includes protecting against sexually transmitted infections. It also includes guarding against an unplanned pregnancy. Practicing safe sex is definitely a menopause-related priority.

The Pregnancy Possibility

Although fertility is reduced as women enter perimenopause, pregnancy is still thought to be possible until one year after the final menstrual period. So for perimenopausal women, unplanned pregnancy is still a very real concern. Choosing an effective, safe, and appropriate method of birth control is extremely important in midlife -- when pregnancy can have an impact on health far beyond the reproductive years.

Some effective birth control options for perimenopausal women include the following:

• Oral hormone contraceptives (combined estrogen-progestin or progestin-alone pills)
• Nonoral hormone contraceptives (injection, skin patch, or vaginal ring)
• Intrauterine devices (IUDs)
• Sterilization (tubal ligation for women and vasectomy for men)
• Barrier methods (diaphragm, cervical cap, spermicides, and male and female condoms)
• Emergency contraception (recommended for unanticipated, unprotected sex and if the condom falls off)

Natural family planning (rhythm or periodic abstinence) is not a reliable method for perimenopausal women, as the timing of “safe days” is so unpredictable due to irregular periods.

The consistent levels of hormones contained in hormonal contraceptives masks changes in a woman’s period and other signs of approaching menopause. Because of the difficulty in determining when women reach menopause, many clinicians advise women to stop hormone contraceptives at age 51, the approximate average age of menopause. At this age, however, not all women will have reached menopause, and some may need birth control for a few more years. A healthcare provider can help a woman make the most suitable birth control choice based on her medical history, lifestyle, sexual habits, and personal preference.

Sexually Transmitted Infections: A Very Real Danger

Women who divorce or lose their partner and reenter the dating world may be at risk for sexually transmitted infections (STIs) -- sometimes called sexually transmitted diseases (STDs). The risk of STIs (including syphilis, chlamydia, gonorrhea, genital herpes, genital warts, hepatitis B, HIV, and others) is a lifelong concern for any sexually active woman who is not in a long-term, mutually monogamous relationship.

STIs are more easily transmitted man-to-woman than woman-to-man. If exposed, women are twice as likely as men to contract gonorrhea, hepatitis B, and HIV. Women are also less likely to exhibit symptoms of these infections until serious problems develop, making them more difficult to diagnose.

Sexually active postmenopausal women with vaginal atrophy may be at increased risk for STIs because the delicate vaginal tissue is prone to small tears and cuts that can act as pathways for infection.

Although lesbian women have fewer STIs than heterosexual women, STIs can be passed from woman-to-woman. Taking the following precautions will aid in prevention:

• Prevent transfer of any body fluids, including menstrual blood and vaginal fluids, to cuts or other openings
• During oral or vulva-to-vulva sex, cover the partner’s vaginal area with a latex barrier to avoid contact with vaginal secretions
• Avoid sharing sex toys and either clean them in hot, soapy water or use a new condom before switching users 

Not only can STIs be uncomfortable, they can also be life threatening. The following safer sex guidelines are important for all women, including those who have had a hysterectomy or ovaries removed.

• Choose partners selectively.

• Discuss sexual history with a partner; don’t let embarrassment compromise health.

• Always insist that a male partner use a latex condom for genital, oral, and anal sex, unless you are in a long-standing, mutually monogamous relationship. Never use petroleum-based products (Vaseline, baby oil) to lubricate condoms because they can damage the condom, potentially causing a leak).

• Keep medically fit and have a regular physical exam, including a Pap test and other tests to identify sexually transmitted infections if you are at risk. If exposed to an STI, or after a confirmed diagnosis, urge partner(s) to be examined and treated. Do not resume sexual activity until you and your partner are cleared of infection or, in the case of STIs that cannot be cured (such as herpes), until proper methods for optimal protection are understood and used.