Understanding the Change

In a phenomenon some sociologists have dubbed "youth creep," the meaning of middle age in America today is different than what it was just a generation ago.

Doctors now consider 55, rather than 40, as the turning point into middle age. Women reaching their 40s and 50s today can look forward to a vigorous, active, and healthy middle and old age-particularly if they take responsibility for the preventive health care that can help keep them in good physical and mental condition.

Changes at Midlife

Women may notice the first signs of bodily changes in their menstrual patterns, skin, and shape as early as their late 30s.

Menopause-the cessation of the menstrual cycle-is certainly the most notable sign of advancing age for women.

The hormonal changes that spur the end of menstruation affect our entire bodies, from the texture of our skin to the condition of our heart and bones.

The medical definition of menopause is the end of menstruation, so menopause can only be diagnosed after the fact. But the bodily changes leading up to menopause may take place over a decade. Most women reach menopause between the ages of 45 and 55.

At age 52, 80 percent will no longer be menstruating. There does not appear to be any consistent relationship between a woman's age at the onset of menopause and her age at her first menstruation, nor does marriage, childbearing, height, weight, or use of oral contraceptives appear to make a difference. However, women who smoke do tend to reach menopause a year or two earlier than nonsmokers.

Birth Control : More Options Than Ever

Over the course of a single year, from 60 to 80 percent of the sexually active women who use no form of birth control will get pregnant. To avoid an unwanted pregnancy, some knowledge of birth control is therefore a virtual necessity.

A wide variety of birth control methods is available. Some are extremely effective. Others are less reliable, but may be more appealing to people with particular beliefs or lifestyles. Several reduce the risk of spreading AIDS and other sexually transmitted diseases; others do not. In this chapter, you'll find the strong points and drawbacks of each. Birth Control Methods That Work Poorly

Among the least effective techniques for preventing pregnancy is withdrawal, in which the man withdraws before he ejaculates. According to the American College of Obstetrics and Gynecology, of all couples who rely on the withdrawal method, one in five will face pregnancy within a year.

Another form of birth control with a poor track record is fertility awareness. Here the woman avoids having intercourse during the days of the month when she is most likely to get pregnant. To determine which days are "unsafe," she keeps track of her past menstrual periods, or notes changes in her basal body temperature or vaginal secretions. The record for this procedure is no better than withdrawal: Chances of pregnancy are one in five within a year.

Both withdrawal and fertility awareness cost nothing or almost nothing, and are accepted by almost all religions. For most women, however, these benefits are outweighed by several disadvantages: the need for continuous self-monitoring, the potential for sexual frustration, and the relatively low reliability these methods provide.

An Effective - But Irrevocable - Alternative

At the opposite end of the spectrum is surgical sterilization, which, short of total abstinence, is unquestionably the most effective form of birth control (though even surgery is not 100 percent reliable).

In female sterilization, or tubal ligation, a doctor seals the fallopian tubes, which carry egg cells from the ovaries to the uterus. In male sterilization, or vasectomy, a doctor seals the vasa deferentia, the tubes that carry sperm from the testicles to the penis.

Although extremely effective, sterilization is meant to be permanent. If the person later changes his or her mind, the operation may be difficult or even impossible to reverse. Sterilization is therefore not a good choice for anyone who might possibly want to have children someday.

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