Contraception for women over 40

Nurse practitioners can help women 40 and older make contraceptive choices that are effective, safe, and appropriate. The noncontraceptive benefits of some methods may be particularly relevant to women in this age group. Providing women with information about continuing fertility as they approach menopause and when it is safe to discontinue contraception may help to reduce unplanned pregnancies.     

Nutrition and health patterns in midlife women.

The middle years for women present many challenges and opportunities. The changes of life--physical, psychosocial, developmental, and environmental--can be rewarding, positive experiences. At the same time, as women enter the middle years, they may face a number of health problems. Preparation for health maintenance, illness prevention, and coping with problems as they occur can prevent many of the potential health alterations through life style changes. Even when these health problems are unpreventable, modification of behaviors and habits may ameliorate some of their consequences. The nurse is the logical person to educate and counsel women on how to lower their risks for midlife health problems. An overview of the health status of women at midlife is presented, including current life expectancy, mortality, and morbidity data. Risk factors and risk assessment specific to diseases prevalent in midlife and older women are reviewed, with emphasis on nutrition and obesity. Nursing strategies for reducing the risk factors (obesity, hypercholesterolemia, and sedentary life style) related to many of the health concerns of midlife women are presented.     

Contraception in immigrant women

The contraceptive behaviour of immigrants is not enough reliable if the great number of abortions is considered. Possible explanations for this fact are immigration itself but also the cultural background. Within the practical guidelines for transcultural contraceptive counselling, the most important points are a low access limit, the use of translators and mediators familiar with the subject, enough time and a high motivation.     

Contraception in women with IDDM. An epidemiological study.

OBJECTIVE--To study whether suitable contraceptive methods to women with diabetes mellitus in fact are applied. RESEARCH DESIGN AND METHODS--A questionnaire survey on the use of contraceptives in all 18-to-49-yr-old women (n = 261) with IDDM in Funen County, Denmark, and an age-comparable control group, (n = 287) was performed. Data were collected from 1987 to 1990. Response was achieved from 94% diabetic women and 88% control subjects. RESULTS--The overall use of contraception in diabetic women (77.1%) was almost identical to that of control subjects (73.6%). Compared with control subjects, significantly fewer diabetic women were using the OCP (P < 0.005) and partner sterilization (P < 0.05), whereas more diabetic women were sterilized (P < 0.0005). Among diabetic contraceptive users, the IUD, female sterilization, condoms, and the OCP each accounted for roughly 20%. Diabetic women using the OCP were predominantly young, and most had never been pregnant; approximately 20% of them used high-dose formulations. Sterilization was frequently used by older diabetic women, and most of these women had 2 or more children; 27% of the diabetic women using an IUD were nulligravidae. Further, 18% used a method with an unsuitable high failure rate. CONCLUSIONS--Our study demonstrates that diabetic women are not sufficiently advised concerning use of contraception.     

The contraceptive needs of midlife women

For those women who have not been contraceptively sterilized, midlife is a period of waning fertility. However, the occurrence of anovulatory menstrual cycles is unpredictable. Contraceptive methods also become increasingly contraindicated, both medically and physiologically. This article reviews the physiology of waning fertility and midlife contraceptive options, and discusses implications for helping women meet their contraceptive needs throughout the perimenopausal period.     

Divorce transition differences of midlife women

Divorce transition experienced by and its influence upon midlife women's health is not fully understood. Interviews were conducted with 24 divorced women who self-classified into decider status groups: initiator (who first decided to end marriage), non-initiator (recipient of end of marriage decision), and mutual decider (shared decision to end marriage). Interpretive content analysis involving pattern coding was conducted. The divorce transition by initiators (n=8) included self-focused growth, optimism, and social support losses and opportunities, while the divorce transition by non-initiators (n=8) included being left, ruminating, vulnerability, and spiritual comfort. No profile emerged for the mutual-decider group (n=8). This study supports that differences in divorce transition exist for initiators and non-initiators.     

Contraception for adolescents.

The two major groups of contraceptives available to adolescents are simple and prescribed methods. Of the former, spermicidal agents and condoms alone or in combination offer some protection. Of the prescribed methods, oral contraceptives and intrauterine devices offer best protection. The risk of pregnancy and the mortality and pathologic risks involved in the use of each method must be considered. The indications, contraindications and specific guidelines for prescribing contraceptives in this age group cannot be uniformly applied to all adolescents; therefore, individualization is always necessary.     

Constructions of sexuality for midlife women living with chronic illness

AIM: In this paper, we reveal constructions of sexuality that were articulated by women who participated in an inquiry which aimed to understand the experiences of midlife women who live with chronic illness. The aim of this paper is to illuminate sexuality as an important health issue for women living with chronic illness and to offer ways that nurses may acknowledge and facilitate sexuality issues for women. BACKGROUND: The first author, as part of her doctoral study, corresponded with 81 women living with chronic illness. The participatory inquiry was framed by feminist principles and enabled women to anonymously share their experiences and collaborate in the direction of the research. During the analysis phase of the research, it became evident that illness had altered the way in which women conceptualized sexuality. DESIGN: The three authors performed secondary analysis of the original data set in order to re-examine the impact that chronic illness had on the sexuality of midlife women who live with chronic illness. Whilst we acknowledge that sexuality has multiple meanings, in this paper we describe the way in which women themselves have constructed and articulated their sexuality. FINDINGS: We found that sexuality incorporated women's desires, appearance, sexual feelings and expression and imposed on aspects of their lives that they had not needed to acknowledge before illness intruded. Three concerns are discussed; the changing body, meeting the needs of others and communicating sexuality. CONCLUSIONS: This paper reveals that issues of sexuality are an important health concern for women who live with long-term illness and should be acknowledged in sensitive and responsive health practices. The paper concludes that it is important for nurses to provide women opportunity for open and genuine communications about sexuality. In this way, a foundation of acceptance for the whole person is established which provides women permission to ask questions and seek assistance with sexuality issues.     

Determinants of health promotion in midlife women

Health locus of control, self-esteem, and health status were analyzed for their impact on health-promoting life-style activities in 262 women between 35 and 65 years of age. Negative chance health locus of control, self-esteem, current health status, health worry/concerns, post-high-school education, and internal health locus of control explained 25% of the variance of likelihood to engage in health-promoting life-style activities. Two canonical variates explained 72.8% of the variance in the criterion set, the subscale scores of the Health-Promoting Lifestyle Profile (Walker, Sechrist, & Pender, 1987). Internal health locus of control, self-esteem, current health status, and future health status explained 36.3% of the variance of the self-actualization, interpersonal support, and exercise subscales; age, negative chance health locus of control, health worry/concern, and negative (poor) prior health status explained 36.5% of the variance of the health responsibility, nutrition, and stress management subscales. The canonical correlations for the two variates were .78 and .66, respectively. The study results support in part the relationships posited in the Pender health promotion model and previous research on women's health.     

Contraception for the teenager.

Although adolescents are now fecund at an earlier age, they are not ready for parenthood financially, educationally, or socially until a much later time. More and more states directly or indirectly permit minors to consent for their own contraceptive needs, a trend that must be applauded. Studies of adolescent attitudes, knowledge, and use of contraceptives indicate a woeful ignorance and lack of use, even among college students. From a medical and practical point of view, the IUD is considered the most suitable contraceptive for the teen-ager. A well-established menstrual cycle of at least 2 years should be be present if oral contraceptives are used. Abstience, although medically ideal, must be initiated by the patient; otherwise, the failure rate is high. The failure rate for the condom, diaphragm, and spermicidal foam is high, except when 2 methods are used at the same time. Coitus interruptus, douche, and rhythm have no application for adolescents. Girls who have had an abortion should receive contraceptive counseling immediately following the abortion. Sterilization must be considered very cautiously for this age group.     

Developmental concerns and the health of midlife women

Prior to providing anticipatory guidance to a woman approaching or at middle age, the nurse should explore her own and her client's expectations of middle age and work to dispel any existing myths. Menopause is not inevitably a time of increased depression or nervous symptomatology. In addition, women whose children are gone from the home are not at increased risk for depression or low life satisfaction. However, we do know that the majority of women experience vasomotor symptoms including hot flashes and night sweats which are directly attributable to the hormonal changes accompanying menopause. The middle-aged woman may begin to note changes in her physical appearance and level of physical energy. This point in life can also be associated with a variety of transitions, including changes in the parental and marital role, the care and death of aging parents, and the loss of a spouse through death or divorce. As the familial environment changes for a woman, work outside the home may take on a different meaning. This stage of life can be one of growth as the woman seeks new directions or it can be a time of dissatisfaction. No one factor distinguishes those who cope well from those who do not. When identifying those women at risk for midlife developmental crises, the nurse must consider the interaction risk for midlife developmental crises, the nurse must consider the interaction of multiple factors. Preliminary evidence suggests that some women may experience a decreased sense of life satisfaction at the time of menopause.(ABSTRACT TRUNCATED AT 250 WORDS)     

New diabetes screening criteria for midlife women evaluated for coronary heart disease risk

The usefulness of new, lowered diabetes diagnostic criterion to identify undiagnosed diabetics in a high-risk sample of women was evaluated. Participants were 228 midlife women undergoing screening for heart attack risk. Fasting plasma glucose levels of participants who were not diagnosed with diabetes were examined to assess the number of women who would meet diagnostic criteria for diabetes using old (140 mg/dL) and new 126 mg/dL) American Diabetes Association criteria. The new criterion identified more women than did the old criterion, particularly African Americans. Use of the new criterion flagged nearly 50% as many women as originally diagnosed as diabetic at the time of screening. Early identification of diabetes may afford earlier, preventive interventions that may reduce morbidity and mortality. Thus, findings from this study suggest that use of the new, lowered diabetes diagnostic criterion may have significant public health benefits for midlife women.     

Contraception for the postpartum woman.

The postpartum woman has the full array of contraception options available to her to prevent a subsequent pregnancy. Two factors may influence the choice of the method and the timing of the onset of use (when pregnancy risk increases): the infant feeding mode chosen and the reproductive involution process. The major controversial area regarding contraception postpartum is the use of oral contraceptives if the mother is breastfeeding (ie, if and how do steroids affect the lactation process or infant health). This article reviews the physiologic and hormonal changes that occur after birth, examines the data available in relation to the influence of steroidal contraceptives on lactation, and presents postpartum implications of the use of the spectrum of contraceptive choices. The nurse can provide an important role in counseling postpartum women regarding contraceptive alternatives and supporting families in attaining their childbearing goals.     

Stress and coping of midlife women in divorce transition

This article describes stress and coping by decider status. Participants were 154 women aged 34 to 54 years who were recently divorced from their first marriage and were married 3 years prior to divorce. Participants self-selected into decider statuses as initiators, noninitiators, or mutual deciders. Noninitiators indicated not knowing the divorce experience was going to occur, not having enough time to get ready for it, saw it as something someone else did, and perceived it as a threat. Initiators and mutual deciders viewed the divorce as a challenge. Noninitiators were less positive about the divorce experience than were initiators and mutual deciders. Acceptance or resignation differed significantly for noninitiators and mutual deciders but not between noninitiators and initiators. Characterizing midlife divorce transition experiences provides a foundation for developing primary intervention to support personal growth, healing, and a healthy lifestyle.     

Transition into midlife.

During the midlife years, ages 35 through 65 years, women experience a series of transitions. How the transitions affect the midlife woman depends, in part, on her vision of those transitions and her strategy for dealing with them. This chapter provides a framework for understanding the transition process. In addition, it provides strategies for attenuating the psychological, physiologic, and social changes that often result with the transition into midlife.