Using Hormonal Contraception After Age 40

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Is it risky or even effective for women over 40 to use hormonal birth control? Dr. Andrew Kaunitz presents the following case vignette in a published article in the New England Journal of Medicine:

"A healthy, lean 46-year-old woman who is a nonsmoker requests advice about contraception. She notes that her menstrual periods are less regular than previously, and she also reports intermittent bothersome hot flashes. She is in a new relationship after a divorce, and she is sexually active. She asks if she can begin to use an oral contraceptive. What would you advise?"

Options for Women Over 40

If you are a woman age 40 or older, then listen up. It's been revealed that your available birth control options have expanded. No longer are your choices somewhat limited to condoms, diaphragms, and tubal ligation.

Dr. Kaunitz, a member of the Department of Obstetrics and Gynecology of the University of Florida College of Medicine, published research in the March 20, 2008 volume of the New England Journal of Medicine that examines women's use of hormonal contraception after age 40. Dr. Kaunitz explains that since the estrogen found in many of today’s combination birth control pills has been dramatically reduced, the pill is now considered a safe alternative for slender, healthy women over age 40.

Other Benefits for Women Over 40

Dr. Kaunitz further points out that many women may prefer the pill because it can:

  • Reduce irregular menstrual bleeding
  • Help control hot flashes
  • Help reduce hip fractures
  • Reduce the risk of ovarian, endometrial, and colorectal cancer

Risk of Dangerous Blood Clots

Keep in mind, though, that the risk of dangerous blood clots does sharply rise at age 40 for women who use estrogen-containing birth control pills, with an estimated incidence of more than 100 cases per 100,000 people (as compared to 25 cases per 100,000 persons of adolescent age).

The risk of venous thromboembolism is nearly twice as high among obese women as it is among non-obese women who use oral contraceptives.

If you are a 40-plus-year-old woman who is obese, smoke cigarettes, have migraines headaches, high blood pressure, or diabetes, Dr. Kaunitz's research suggests that the risk factors associated with combination birth control use are considered to outweigh the benefits. But, there is still good news. Women over 40 with these risk factors could still be excellent candidates for the ParaGard IUD, or for progestin-only contraception options.

Use of Birth Control in Women Age 40 and Older

Hormonal contraception has recently been a necessity for the 40-something population given that many women are choosing to put off child-rearing until a later time, so sterilization, like having one's tubes tied, may just not be a good choice. Interestingly, statistics reveal that 40-plus aged women are the least likely to use birth control, yet (along with teens), these older women have the highest abortion rates.

However, Dr. Kaunitz reports that 40-plus women of reproductive age who use contraception are "more likely to use contraceptives correctly and consistently than younger women. Accordingly, women in this age group have lower rates of contraceptive failure than do younger women."

The expansion of 40 plus women's contraceptive options will find many women happily enjoying satisfying sexual relationships without the need to worry about getting pregnant.

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Article Sources

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  • Kaunitz AM. Hormonal Contraception in Women of Older Reproductive Age. New England Journal of Medicine. 2008;358(12):1262-70.