The bladder. For some unknown reason the ovaries have a ‘use-by’ date. After a time of useful function, when they can produce eggs to make babies, they and their neighbour (the uterus) down tools and walk off the job, so to speak. Usually the rest of the body has a couple of decades to go, but not the reproductive hardware.

There may be an increase in the incidence of urinary tract (bladder) infections in menopausal women. The lack of vaginal lubrication, and the changing anatomy can contribute to this. Urinary incontinence is accidental weeing, brought on, for example, by coughing and sneezing, and the feeling of not being able to ‘hold on’. It may result from the mechanical changes to the urinary system, like prolapse, or the lack of hormones. Also more common is bladder instability (frequently passing small volumes of urine, in the absence of infection). This is related to the muscles of the bladder, which tend to work more effectively when there is more oestrogen around.

The breasts. The breast tissue also changes, becoming less dense. This can cause the breasts to sag. The nipples tend to become flatter. They do not respond to stimulation by becoming firmer as readily as they did in the past.

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Where can I get a vasectomy? Some doctors do vasectomies under local anaesthetic in their surgeries. You can also have a local anaesthetic vasectomy at some Family Planning Centres, and at some public or private hospitals or private clinics. Some of these places also offer the option of light sedation. This is a drug given intravenously which doesn’t put you completely to sleep but does make you feel very relaxed and lessens any discomfort felt during the operation. Vasectomy under general anaesthetic is done in a hospital or day surgery.

What does a vasectomy cost? The cost of the operation varies a lot depending on whether you have it done by a specialist or general practitioner, in or out of hospital or under general or local anaesthetic. Medicare will cover some of the costs and in some cases so will your private health fund if you have medical insurance. Be sure to sort out the costs you will face with the doctor who will be performing the operation before you book in for surgery, and to check first with your health fund if you are thinking of making a claim through them.

Things to think about for men considering vasectomy

• Why do you want to have a vasectomy? Do you feel absolutely sure that you want to take this permanent step to prevent you from fathering children?

• Could it be possible that you would want another child if you have children now but they died, or if your partner died or your relationship broke up?

• How would you feel if you had a new partner who wanted to have a child with you?

• Are you, or your partner, worried that if you have a vasectomy, sex may not be so enjoyable?

• Do you have any doubts about having a vasectomy? If you do it is very important to talk them over with the doctor before you decide to have the vasectomy.

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Are there any reasons why I could not use Natural Family Planning?

If your partner is not prepared to co-operate, or could be unreliable, you probably won’t be able to use a natural method. If you are not prepared to take note of your physical changes every day, or you are not prepared to avoid vaginal sex for fairly long periods of time, then a natural method would not be a good choice.

If an unplanned pregnancy would cause serious problems, then you would not be advised to use a natural method, unless there is really no other choice, because the risk of failure would be too great.

Things to think about if you are considering using Natural Family Planning

• If you are worried that you have made a mistake in your calculations, and you have had sex when you are probably fertile, you have the choice to use the emergency contraceptive pill. But be aware that if you use it your menstrual cycle will most likely change over the next month or so, and you will not be able to rely on a natural method until your cycles return to what is normal for you.

• Remember both partners have to be committed to using a natural method for it to be effective.

• Natural methods do not give you any protection against sexually transmitted infections (STIs).

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Why would I want to choose DMPA?

You may want to use DMPA if you definitely don’t want to become pregnant and you have tried the Pill, but you keep forgetting to take it You may want to use DMPA if you have already had an unplanned pregnancy after forgetting to take the Pill. You may want to use DMPA if you think that you will find it hard to take the Pill every day, and you really don’t want to risk an unplanned pregnancy. Perhaps you just don’t want to have to remember to use contraception all the time, and you think having an injection every three months would be easier. You might think about trying DMPA if you cannot use contraception containing oestrogen for health reasons or if you get problem side effects from it. You can use DMPA safely when you are breastfeeding.

Are there any reasons why I could not use DMPA? You cannot use DMPA if mere is any chance you could to pregnant. You may be advised not to use it if you have breast cancer, or any breast problems that have not yet If you have a medical problem that means you cannot have an injection into your muscles, you will not be able to have DMPA. If you have any medical conditions, you should let your doctor know before you use DMPA, just to make sure it will not cause problems.

Does DMPA have any side effects? The main side effect of DMPA is that women’s periods usually change. Periods are more likely to get lighter, but they occasionally get heavier and they can become quite irregular. You may have a bit of spotting between periods. You may stop bleeding altogether after a few injections. This is okay and will not harm you. Some women also gain weight, or have headaches or feel depressed. If this happens to you, see your doctor.

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Cervical caps are between 82 to 90 percent effective. That means that if 100 women used a cap as their method of contraception for one year, between 10 and 18 of them would have an unplanned pregnancy. Some of those pregnancies would have been due to the woman not using the cap properly. If you use the cap correctly every time, it is much more reliable.

Why would I choose a cervical cap? A cap may be a good choice for you if you have tried a diaphragm but it didn’t suit you. Some vaginal muscles aren’t able to keep a diaphragm in place. If a diaphragm irritates your bladder, a cap could be better for you. And if you are inclined to put on weight and take it off fairly regularly a cap is a good option, because the size you need doesn’t change with your weight.

You only need to use a cap when you have sex and it just stays in the vagina so it doesn’t affect the rest of your body. If you look after it properly, a cap can last for two years, so although it costs more than some other methods at first, you don’t have to pay again for about two years so the cost is really quite reasonable.

Are there reasons why I may not be able to use a cervical cap? Some women have the type of cervix that does not suit a cap. You won’t know about this until you have been examined by a doctor or nurse. You would not be able to use a cap if you, or your partner, are allergic to latex, but this is very rare.

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