事件记录
你的计划生育做得很好. 你总是采取避孕措施，但你什么时候才能停止? 这是 Dr. 外裙琼斯 从 妇产科 here at University of Utah Health Care and this is 范围.
所以你一生都在计划你的孩子. 你想要孩子的时候就生了. 你没有多余的孩子. 你真的很擅长，但你什么时候能停下来? The answer is when you or your partner are using some form of really good birth control so you can stop. 如果你的伴侣有 输精管结扎术嗯，那太好了.
生育能力下降和并发症风险
现在，一个很好的避孕方法是 更年期. So let's talk a little bit about your contraceptive method and 更年期. 首先，大发娱乐知道，生育率从30岁左右开始下降. We know that women who are trying to get pregnant sometimes struggle in their late 30s and certainly do in their 40s. The difficulty is that a pregnancy in your 40s that's unplanned is a definite problem because women in their 40s who get pregnant, 尽管它们不是很肥沃, 在怀孕期间是否有较高的并发症风险, 比如高血压和糖尿病.
They're actually more likely, believe it or not, to have twins. And they have more complications in terms of blood loss and a whole lot of other problems just with the pregnancy. 当然, we all worry about the difficulties in chromosomal abnormalities in our babies that increases in women after their 30s. 所以女性在怀孕期间更容易出现并发症. They are more likely to have a baby with a chromosomal anomaly like Down syndrome and importantly, 他们更容易流产. And by the end of your 40s, you are really likely to miscarry.
更年期作为避孕手段
然而, you don't want to get pregnant even though your chances are low. So when, even if you're being very careful, when is it time to stop? 好吧. 现在大发娱乐来谈谈更年期. Menopause is defined as when you haven't had a period for a year. 那么一年前的最后一段时间就是你的更年期. 现在，你得适龄才行.
So the average 20-year-old who hasn't had a period for a year is probably not in 更年期. 她的蛋还没吃完. 她不来月经可能另有原因. But women in their late 40s and early 50s who haven't had a period for a year are very, 很有可能处于更年期. 如果你一年没有来月经, 然后 you're likely in 更年期 and you can stop using your contraceptive method.
然而, it's difficult to know if you're in 更年期 based on your periods if you're using a contraceptive method that changes your periods. 让大发娱乐以避孕药为例. Birth control pills block ovulation but give you hormones that make you have a period every month. 所以你可以进入更年期, 没有更多的鸡蛋了, 完全不育, 而是因为你在吃药, 你每个月都会来月经.
So how do you know, if you're on birth control pills, that you're in 更年期? 好吧, the difficult answer is you have 让你停止服药 and 看看会发生什么. 如果你停止服药, 你大概52岁, 你的例假只有六个月, 那么你就进入更年期了. 但如果你是52岁呢, 而且你还能生育, 然后停止服药, 然后你就怀孕了? 好吧, 选项是, 当然, 让你停止服药, 看看会发生什么, 使用不同的方法, 屏障法, 使用避孕套, 使用泡沫. 还记得, you're not very likely to get pregnant because you're not very fertile and you're not very likely to stay pregnant because you're likely to miscarry. 这是一种选择.
另一个选择是说, “嗯, why don't I just stay on my pills because going through the peri更年期," those years when your periods are totally unpredictable and not very pleasant, "why don't I stay on these nice little periods that I like on the pill until I'm about 54?" We know that at 54, about 90% of women have gotten through 更年期. At 50, the average age of 更年期, only 50% of women are menopausal. 但到了54岁，大约85%到95%的女性进入了更年期. So you just stay on your pills and stop at 50 and you're very likely to be done.
宫内节育器和注射避孕
大发娱乐来谈谈含有激素的宫内节育器. 对于有宫内节育器的女性来说, many of those women have very light periods or no periods at all so you may not know that you're in 更年期. You may have some hot flushes because your estrogens have gone away. 你可以验血, 哪些对服用避孕药的女性效果不太好, 但它对含有激素的人有效 IUD. You could do a blood test called FSH and if that is really high, 那么很可能, 没有保证的, 但很可能, 你已经没有卵子了，进入更年期了.
Or you can just stay on that IUD that has some hormones in it until you're about 54. And many women in their early 50s who have hot flushes may want to take a little estrogen and they have the progestin protection. They protect their uterus lining against abnormalities with that little hormonal IUD. So wait until you're a little older and 然后 take your hormonal IUD out.
如果你像Depo-Provera那样开枪, about 80% of women on Depo-Provera don't have periods so you won't know when you're in 更年期. 好吧, the same kind of strategy goes with Depo-Provera as it does with the hormone-containing IUD. You can just wait till you're a little older or you can stop, use a backup method. You can stop your shots, use a backup method, and wait and see if you start your periods again.
这是一个复杂的问题. 好消息是，对于那些停止避孕的女性来说, 不管是什么, at 50, 然后, 事实上, 怀孕的几率非常低. 对你来说到底有多低? If the chances of getting pregnant and having a baby is 50 to 1 in 100, 你愿意为这个数字冒险吗? 不是我. 对我来说, 这是没有, 我不会冒百分之一的风险生孩子, 考虑到50岁怀孕的种种并发症. So I was much more willing to push my contraception out to 54 and 然后 say, “现在我准备好了."
所以这是个人的选择. 这是一个你和你的搭档讨论的问题, 和你的家人, 如果你想这么做的话, 关于他们对未来生育的看法, what kinds of risks are they willing to take if you do get pregnant? But definitely talk with your clinician because there are some options that are really good ones to make this transition with low fertility, 但仍然有一些生育能力, 还有一些治疗更年期症状的好方法.
So many women actually use a low-dose birth control pill to help them with their 更年期 symptoms. 这是一个难题的难解答案, but I want to say good for you for having been such a good contraceptor all these years. 感谢收看《大发娱乐》栏目.
更新日期：2021年1月28日
最初发布日期：2016年9月29日