ABSTRACT
Traditionally, initiation of hormonal and intrauterine methods of contraception has been delayed until the next menstrual period, mainly to avoid inadvertent use during pregnancy. However, that risk from starting a “medical” method at the time the woman is first seen – quick-starting – can be minimized as above by a careful sexual and menstrual history. For healthy women with diminishing ovarian function but who need contraception as well, this is often preferable to standard hormone-replacement therapy, which is not adequately contraceptive, along with having to use some other contraceptive. “Menopause is usually a clinical diagnosis made retrospectively after 1 year of amenorrhoea.” Although hormonal methods mask the menopause, it is not always necessary to know the precise time of final ovarian failure. Finally, should there be any doubt about the normality of any bleeding during the time course of any of these plans, investigate it—as always—as possible post-menopausal bleeding, to exclude malignancy.
