Using Hormonal Contraception After Age 40

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It's no secret that there are more birth control options available than ever before for women who want to actively avoid becoming pregnant. While the same birth control you used in your 20s and 30s may be just fine in your 40s and may even offer some potential benefits, that may not be the case for all women. There are various things you should consider when deciding which method of birth control to use now that you're 40-plus.

Use of Birth Control in Women Age 40 and Older

Until a woman reaches menopause, it's not possible to know exactly when the risk of becoming pregnant is eliminated. As such, it's important for all women to actively protect themselves if they are certain they no longer wish to have children.

Despite the risks associated with becoming pregnant after having reached advanced maternal age (35), research shows that 40-plus aged women are the least likely to use birth control. However, it's important for this population of women to have access to reliable birth control for many reasons, but mainly because some are choosing to put off childbearing until a later age, and some are purposely choosing not to bear children at all. Because the exact age at which pregnancy is not possible is not known, it's important for these women to be able to protect themselves and their choices. Ultimately, and not surprisingly, having more contraceptive options available will allow many 40-plus women to enjoy satisfying sexual relationships without needing to worry about getting pregnant.

Benefits of Hormonal Contraception

The most obvious benefit of hormonal birth control is that it is highly effective at preventing pregnancy. In the past, it was commonly believed that for women over 40, birth control options were limited to non-hormonal methods such as condoms, diaphragms, and even tubal ligation. However, research shows that the benefits of oral contraceptives containing progestin and/or estrogen outweigh the risks and are considered to be safe methods of birth control even for healthy women over 40. Although fertility declines as women get older, it's still important to actively prevent unintended pregnancies because of an increased risk of health complications including preeclampsia, gestational diabetes, premature birth, and birth defects.

But the benefits of hormonal birth control aren't limited to simply preventing pregnancy. Many women also 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

Risks for Women Over 40

Just like for women of any age, hormonal contraceptives come with risk factors that vary among women depending on their age and various lifestyle factors.

One factor to consider if taking birth control over age 40 is 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 eight to 10 cases per 10,000 people. If you're at an increased risk for cardiovascular events such as heart attack or stroke, your doctor may determine that estrogen-containing birth control should be stopped after age 40, even if it may have worked well for you in your 20s and 30s.

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

Additionally, if you are a 40-plus-year-old woman who is obese, smokes cigarettes, has migraine headaches, high blood pressure, or diabetes, research suggests that the risk factors associated with combination birth control use are considered to outweigh the benefits.

A Word from Verywell

Because of the risks associated with the use of certain methods of birth control in women over age 40, it's important that you share all lifestyle factors and family history with your doctor. For example, if you've started smoking or have developed hypertension over the last couple of decades, that's something your doctor should know. Women over 40 with higher risk factors with estrogen-containing methods could be excellent candidates for the Paragard IUD, or for progestin-only contraception options, for example. At the end of the day, what works well for one woman may not necessarily be the best option for another.

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Article Sources
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  1. Guttmacher Institute. Contraceptive use in the United States. Updated July 2018.

  2. Centers for Disease Control and Prevention. When Women Can Stop Using Contraceptives. Updated February 1, 2017.

  3. Centers for Disease Control and Prevention. Contraception. Updated November 1, 2019.

  4. Allen RH, Cwiak CA, Kaunitz AM. Contraception in women over 40 years of age. CMAJ. 2013;185(7):565-73. doi:10.1503/cmaj.121280

  5. March of Dimes. Pregnancy after age 35. Updated April 2016.

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