Do women still need contraception during menopause?

　　The cause of menopause is that the ovaries gradually shrink and ovulation decreases and gradually stops. Uterus Without the stimulation of estrogen secreted by the ovaries, the body gradually shrinks accordingly. The ratio of the uterus to the cervix decreases from 4:1 during the fertile period to 2:1 at the end. Uterine weight and uterine cavity volume are also reduced. menopause Menstrual irregularities have occurred before, and ovulation occurred occasionally. The possibility of pregnancy cannot be completely ruled out, but the chance is very small.

　　If there has been no menstruation for more than 1 year, it can be considered that the endometrium has been relatively atrophied. Not only has there been no change in the secretory phase, but endometrial hyperplasia is not obvious. In this case, even if a fertilized egg enters the uterine cavity, it will not be able to provide a place and nutrition for the implantation and development of the pregnant egg. Therefore, contraception can no longer be used and the IUD can be removed.

　　There are many types of intrauterine devices, each with its own characteristics. The most basic principle is to act as a local foreign body, such as:

　　1) Damage

　　The surface layer of the endometrium causes an increase in leukocytes, especially macrophages, which not only engulf sperm , fertilized eggs and embryo sacs, and also interferes with implantation of fertilized eggs.

　　2) Local stimulation

　　It causes the endometrium to produce prostaglandins, accelerates peristalsis in the fallopian tube, and causes the fertilized egg to enter the uterine cavity prematurely, which is out of sync with the cycle of the endometrium and is not conducive to implantation.

　　3) Copper IUD

　　Reducing the amount of zinc in the endometrium causes changes in the essential carbonic anhydrase that the blastocyst attaches to the surface of the endometrium, and at the same time accelerates the atrophy of the endometrial glands.

　　4) Increase many chemically active substances in the uterine cavity

　　Such as lysosomal hydrolase, protein, non-protein nitrogen, etc., indicating tissue disintegration. In addition, the immunoglobulin content in the serum increases, which has an immune and anti-implantation effect.

　　5) Non-specific inflammation of the endometrium

　　For example, in tissue reactions, a large number of neutrophils and dissolved substances in uterine fluid and endometrium have the property of killing blastocysts, creating an extremely unsuitable environment for fertilized eggs.

　　All of these have the adverse effect of accelerating the degeneration of the postmenopausal uterus. The size of the uterus becomes smaller, but the IUD will not shrink, and it is easy to become incarcerated, causing stomach ache , or even penetrate outside the uterus, irritating the abdominal cavity and causing adverse reactions, which requires laparotomy to remove. It is speculated that if the IUD is left in the uterine cavity of an older person for a long time, which has weak resistance, the possibility of causing uterine cavity infection and pus accumulation is high.

　　If the intrauterine device causes endometrial damage and bleeding, it will make the diagnosis of reproductive organ tumors more difficult. Therefore, it is better to remove the IUD one year after menopause. The longer the time, the greater the difficulty in removal, because the cervix becomes smaller, and the greater the chance of the IUD becoming incarcerated. However, it was recently reported that no increase in severe endometrial inflammation or worsening of discomfort symptoms was found during follow-up of a group of women who had been postmenopausal for many years but had not removed their IUDs. Therefore, this issue requires further observation.