Dr Thomas Stuttaford's next online forum (live on February 20, after 1pm) is : moles and skin cancer. To ask the doctor your question on this topic and to read other recent topics he has answered click here

Q1: I am 47 years old, have not had children and have been on the pill since I was 18. In that time I have had two breaks of maybe three or four months duration. I take a combined pill as the other does not agree with me. I sometimes feel that maybe I am going through the menopause – the odd hot flush, slightly irrational and emotional behaviour (per my husband). Is this possible as I am only 47? How would I know as I am on the pill? I still bleed every month – sometimes it is rather light and lasts for a couple of days rather than the usual four to five days. If I were to stop taking the pill after all this time – what are the possible problems or advantages, for that matter, that I might experience? Would it be necessary to replace the pill with some form of hormone replacement therapy? B. Lucas, Carcassonne, France.

A1: So far as contraception is concerned it is even more important to treat everybody as an individual because the choice of method has to be selected to fit their age, domestic situation, smoking history, temperament and their own past medical history as well as their families medical history. It is therefore important for women to establish a good, chatty relationship with their own GP, or one of the doctors at whatever clinic is providing family planning advice. In general it is unusual for a woman still to be taking the combined pill at the age of 47. Some doctors would suggest that it is better if the combined pill is only taken for ten to fifteen years. In my own practice we usually tried to arrange for women to come off the combined pill at about the age of 35 or 36 and to change to either the mini pill - this is not quite as contraceptively certain as the combined pill - or to have a Mirena intra uterine device fitted. This particular intra uterine device has the advantage over an ordinary IUD in that it reduces the incidence of bleeding and it isn't so likely to render the patient vulnerable to infection. Standard IUDs can act as a ladder for organisms to gain access from the vagina to the intrauterine cavity.

The normal pattern of bleeding as the menopause approaches is for the blood loss to be less and for the time between the bleeds to become greater.

It is not usually necessary to replace the pill with some form of hormone replacement therapy but just so that there can be no doubt about pregnancy I usually recommend either the mini pill, or recently more often a Mirena intrauterine device for women at this time of their life.

You raise an important point about the tests that can be done to determine whether someone taking the combined pill is still pre-menopausal. The standard advice is that the patient should first come off the pill, use a condom and let the almost immediate break-through bleeding pass. They should then have a completely normal cycle, for only after they have had their first true period, rather than break-through bleed, have a hormone assay carried out by a competent laboratory. The laboratory will measure the FSH, LH and oestradial levels. It is then also possible to measure your ovarian reserve - how long your ovaries are likely to continue operating. I always sent my patients to the Doctor's Laboratory at 55 Wimpole Street, W1 but the NHS will run a similar if less speedy service.

Q2: I am a virgin who is contemplating having sex with her boyfriend. We have discussed various different methods of contraception and would like to have one method, as well as a back up method. As I am reluctant to go on the pill or anything that effects your hormones too much, as I fear weight gain and heavy periods, we came to the conclusion that condoms and spermicide would be the best option for us. Are there any other options available to us that we have missed? Name and address withheld.

A2: Condoms have the advantage that they also reduce the risk of any shared genital infection, whether one of the classic sexually transmitted diseases or only the normal bacteria and fungal spores that everyone's genitalia and crotches harbour. Unfortunately it is very difficult to persuade men to always wear a condom. The condom may be safer from the point of view of infection than other methods of contraception but it is not as reliable as a contraceptive as the pill. I therefore usually recommend the pill, it is also easier if someone is not very sexually experienced.

The combined pill has advantages as well as disadvantages so far as general health is concerned. Most people don't suffer from heavy weight gain or heavy periods from a pill. If you do decide to use condoms it is important to use a spermicide as well.

The pill is contra indicated if you or your family have a history of arterial or venous thrombosis or if there is a very bad family history of arterial disease. The doctor who was prescribing the pill would advise you about this. Some forms of liver disease make the pill undesirable as does SLE, one of the connective tissue inflammatory diseases. Any change in the amount of migraine suffered after taking the pill should be discussed with your doctor. Whoever is prescribing the pill will obviously keep an eye on your blood pressure and explain that although there is a small but real increase in the incidence of breast cancer the incidence of some other tumours is reduced.

You would probably find that the long acting progestogen injections, implants etc. would be more likely to cause weight gain, skin troubles, irregular bleeding than does the ordinary combined pill.