How long do I have to use contraception after menopause?

I am 55-years-old. I had my last full period in Jul 2011. Since then I had the slightest staining around Christmas, which was just once-off.

Am I completely finished the menopause and do I need to use contraception and for how long?

>> You are not ‘out of the woods’ with regards to fertility and contraception until you have experienced a full year without any bleeding or spotting — no matter how remote the chances of pregnancy at this stage. The difficulty with contraception is that hormone-based options can lead to intermittent bleeding, which means that you are unable to reliably detect when you are no longer fertile.

The general rule is that once you have gone a full year without any bleeding (two years for women under 50), then you are considered to no longer require contraception.

In the meantime, barrier methods — such as condoms, caps, and diaphragms are the best choice.

Post-menopausal bleeding is worth investigating with your doctor. In your case the bleed is not in this category, but it is worth keeping in mind for future reference. While 20-30% of women experience this, and no matter how scant or heavy the bleed is, ruling out abnormalities is essential.

The most common triggers for a post-menopausal bleed are hormonal imbalance, insulin resistance, nutrient deficiency, weight loss, or emotional stress.

However, in a small percentage of women the bleeding is a sign of abnormal, pre-cancerous or developed cancerous tissue within the uterus.

¦ My husband is in his early 60s and has been diagnosed with Sjogren’s Syndrome.

He has dry gritty eyes, very little saliva, sinus, very dry hands, gets tired easily, and has raised blood pressure. He also had low Vitamin B12 but this was sorted with injections.

He is on Istin 5mg for blood pressure. His rheumatologist prescribed Plaquenil 400mg once a day for Sjogren’s. I understand this treatment suppresses the immune system. What do you recommend?

>> Sjogren’s Syndrome is far more common among women, with only 10% of patients being men. The symptoms your husband is experiencing are typical of the condition, and most people find that the best treatment is to deal with Sjoren’s on a symptomatic basis.

Plaquenil is prescribed for autoimmune disorders and rheumatic conditions. It is slow-acting, so you will need to give it at least six months to determine how effective it is in relieving the symptoms. This should also help somewhat with the fatigue. One of the key side-effects is something called hydroxychloroquine retinopathy, which can lead to vision loss — so your husband will need to report to his doctor if he experiences any vision changes.

The lack of saliva means dental health will need to be addressed preventatively — bacteria that are responsible for cavities flourish without sufficient saliva. He must ensure that steps are taken to strengthen the enamel and treat any existing cavities, along with having his teeth professionally cleaned on a regular basis.

There are specific products created for dry mouth conditions, such as Recaldent gum (available in mint or grape flavour, 112 pellets cost £20 on breezecare.co.uk). Breeze Care also supply a dry mouth gel which is applied to provide relief from oral dryness for up to four hours at a time, plus it lubricates and protects the tissues.

The treatment for dry eyes is similar — artificial tears, lubricating ointment, warm compresses, humidifying devices, and protection (wrap-around sunglasses). Omega-3 has also been found to provide some relief.