Using Hormonal Contraception After Age 40

Unless you are trying to get pregnant, you will likely need some form of birth control in your 40s and 50s until you have fully transitioned to menopause. While the same birth control method you used in your 20s and 30s may work just as well beyond those decades, there are some real age-related concerns regarding the use of estrogen-containing birth control in some older women.

This doesn't mean that you should abandon the pill the moment you turn 40 (particularly if you are sexually active), but rather that you work with your healthcare provider to consider the most appropriate birth control options as your body and sexual lifestyle start to change.

Pregnancy After 40

Many women in their 40s and 50s will prematurely abandon birth control at the first signs of perimenopause under the assumption that they are no longer fertile. In fact, of all age groups, research has shown that women over 40 are the least likely to use birth control of any sort.

But until you are fully in menopause (meaning there have been 12 complete months without periods or even occasional bleeding), you still need to continue to access a reliable form of birth control if you want to prevent pregnancy.

Given this, it probably comes as no surprise that no less than 77% of women between the ages of 44 and 50 are at risk of unplanned pregnancy, according to a 2016 analysis published in the American Journal of Obstetrics and Gynecology.

Many women age 35 and older have perfectly healthy pregnancies and babies. That said, there are significant health risks in these women that are worth noting. These include the increased likelihood of preeclampsia, gestational diabetes, premature birth, and birth defects. This factors into some women's decision to continue with contraception at this age and until menopause.

Benefits of Hormonal Contraceptives

For some women, continuing with the same method they've always used may be a reasonable option. It may even offer health benefits.

In the past, it was commonly believed that birth control options for women over 40 were limited to non-hormonal methods such as condoms, diaphragms, and even tubal ligation. Those views have changed considerably.

Today, research has shown that the benefits of oral contraceptives outweigh the risks and that combination birth control pills are safe for most healthy women over 40.

In addition to preventing pregnancy, oral contraceptives can help:

• Reduce irregular bleeding during perimenopause
• Control hot flashes and other symptoms of perimenopause
• Reduce the risk of hip fracture in older women
• Reduce the risk of ovarian, endometrial, and colorectal cancer

Risks of Hormonal Contraceptives

While there generally are more pros than cons to the use of hormonal birth control—whether as a pill, patch, or intravaginal ring—it may not always be the best option for women over 40.

One of the major concerns is that ongoing exposure to estrogen may increase the risk of stroke and thrombosis (blood clots) in older women. This includes life-threatening deep vein thrombosis (DVT) and pulmonary embolism (PE).

According to a 2011 review in Pediatrics, perimenopausal women on the pill have between a three- and five-fold increased risk of thrombosis compared to women under 35 who take the pill. (Mini-pills containing progestin only appear to pose no risk.)

Estrogen-containing birth control pills are also associated with a 20% increased risk of breast cancer, especially if taken for more than five years. High-dose estrogen and triphasic pills pose the greatest risk overall. While it is unclear if estrogen-containing patches or rings can increase the risk of breast cancer, most experts believe the risk is low.

Ethinyl estradiol (the type of estrogen used in birth control) can also be hard on the liver and cause injury to women with acute liver disease. The risk appears to be limited to the pill, which is metabolized by the liver, rather than patches or rings, which deliver estrogen directly to the bloodstream.

Health Considerations

As concerning as these risks may be, not every woman on oral contraceptives needs to change treatment the moment she turns 40. In most cases, an immediate change won't be necessary.

As a general rule, you should discuss a change in oral contraceptives if you have an underlying health condition that places you at an increased risk of blood clots, liver injury, or certain cancers.

Some of these conditions are aging-related and may not have been an issue when you were younger. Therefore, a form of birth control that may have been best for you in the past may not be so today.

Among the conditions and factors that contraindicate the use of ethinyl estradiol are:

• A history of DVT or PE in women not on blood thinners
• Vascular diseases, including stroke and peripheral artery disease (PAD)
• Current or prior history of coronary artery disease (CAD)
• Advanced diabetes with vascular disease
• Hypertension over 160/100 mmHg
• Multiple risk factors for cardiovascular disease
• Liver tumors, acute hepatitis, or advanced (decompensated) cirrhosis
• Current or history of breast cancer or other estrogen-sensitive cancers
• Undiagnosed uterine bleeding
• Migraine with aura

Caution should also be used when prescribing estrogen-based oral contraceptives to women who are obese or those over 35 who smoke, as both can increase the risk of cardiovascular disease.

Lifestyle Considerations

Lifestyle also factors into the choice of birth control. After 40, your body will have changed, and there may be other, more appropriate options to consider. Habit alone cannot justify the routine, open-ended use of estrogen if, for example, you don't have sex all that often.

To address these changes, many OB/GYNs will routinely wean their patients off estrogen-containing oral contraceptives after 40, moving them instead to the mini-pill, an intrauterine device (IUD), or barrier methods such as condoms or a diaphragm. Vasectomy in a male partner should also be considered.

A Word From Verywell

Although oral birth control can be extremely safe and effective for women over 40, it is important to understand that there are some risks associated with its use.

To determine if the pill is the right choice for you, speak with your healthcare provider and be honest about anything that may increase your risk of harm during treatment, including smoking, previous cardiovascular events, or uncontrolled diabetes or hypertension. By working together with your healthcare provider, you can find the most appropriate ways to avoid pregnancy while protecting your long-term health.