277 Nursing Care of the Postmenopausal Woman, 3rd Edition
CONTRACEPTION FOR WOMEN OLDER THAN 40
A woman may be instructed to record specifics on pain in a diary or event log. Interview guides also can be used to ad- dress a woman’s sexual function. In this society, sex is a subject that few wish to talk about, especially if one feels that it is not going well. For those women, there are simple, self-administered screening aids to be completed. One of the most frequently used is the Female Sexual Function Index 19, which has 19 ques- tions in sections about the following do- mains: Desire, Arousal, Lubrication, Or- gasm, Satisfaction, and Pain. The 6-item Female Sexual Function Index, which is an abridged version of the 19-question index, is also available. These indexes have been validated in many different countries and cultures (see Table 1-4). | NURSING CONSIDERATION For a nurse to take an adequate sexual history, they must understand their own sexuality and be aware of any sexual bias. The nurse must create an environment of trust and a forum for safe, nonjudgmental information exchange.
As women progress through perimeno- pause, they still need to think about con- traception. Until a woman has gone 12 months without a menstrual period, there is still a chance that she could become pregnant. Although pregnancy is less like- ly after the age of 40, it is possible, and a pregnancy at this stage in a woman’s life can be potentially hazardous. Some of the risks associated with pregnancy in women older than age 40 are miscarriage, chro- mosomal abnormalities, maternal compli- cations, maternal mortality, and neonatal complications. The U.S. Medical Eligibility Criteria for Contraceptive Use is a comprehensive, evidence-based guide to assist in deter- mining when or if a woman is a candidate for contraceptives. The Criteria use the classification categories in Table 1-5 to help determine whether a woman should use a particular method. A woman without any risks may con- tinue to take combined oral contracep- tives until she is approximately age 50; after age 50, the woman should discuss whether she should discontinue oral com- bined contraceptives, and if the risks out- weigh the benefits. Also, combined oral contraceptive pills, the patch, and the ring are contraindicated for women old- er than age 35 who smoke, women who have migraines with auras, women with hypertension, women with diabetes if a complication is present, and women with a family history of cardiovascular issues in a first-degree relative <45 years old (Allen et al., 2019).
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