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Male or female sterilisation is chosen by almost 50% of British couples in their 40s as their main method of contraception. Of these, 15% of men and 12% of women choose either vasectomy or tubal occlusion. Vasectomy is the most effective contraceptive method available, with failures now quoted as having a life-time risk of one in 2000 after two azoospermic samples taken 2-4 weeks apart at least 8 weeks after the procedure. Mirenai (Schering), the levonorgestrel-releasing intrauterine system (LNG-IUS), is an ideal contraceptive method for the older woman. Epidemiological data support the prescribing of combined hormonal contraceptives (CHCs) to non-smoking, normal-weight, low-risk women who do not suffer from migraine until the menopause. The median age of the menopause in Western women who do not smoke is 51.3 years. Symptoms of the menopause are often masked in women using CHCs but some may complain of vasomotor symptoms in the hormone-free week.
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