one quarter of women in the United States between ages 15 and
44 use the birth control pill to prevent pregnancy. Some
doctors advise against continuing its use after age 40, but
women need to protect themselves against unwanted pregnancy
until one year after menopause, which on average occurs at the
age of 51-52.
Pinkerton, the executive director of The North American
Menopause Society, said the second highest rate of unintended
pregnancy is for women 40-50 who are sexually active. Many can
continue to safely take the pill, but some should think about
gynecologist and contraceptive expert at the Mayo Clinic, Dr.
Petra Casey said a woman younger than 40 can safely take the
pill unless she has a history of strokes, blood clots, heart
attacks, hypertension, migraine headaches or other serious
health conditions. After age 40, for healthy women who donít
smoke, the benefits still usually outweigh the risks.
women approaching menopause," said Casey, "the pill
can enable a smooth transition through hormonal changes and
symptoms such as hot flashes."
Gillian Dean the director of the fellowship in family planning
at the Icahn School of Medicine at Mount Sinai in New York,
said women have more options than ever when reassessing their
birth control choices.
methods I discuss most are the most effective and easiest to
use: the IUD and the implant. But if I have a healthy
nonsmoking patient who wants to stay on pills, I counsel her
that itís a safe and effective option all the way until
menopause," she said.
said the combination estrogen-and-progestin pill that works by
thickening the cervical mucus and thinning the lining of the
uterus to prevent sperm from reaching an egg is safe for
middle-aged women with no health problems. The progestin-only
pill or the "minipill" is safe even for those who
have health problems or smoke, because it doesnít contain
the hormone estrogen that can be associated with increased
risk of blood clots and sometimes heart attack or stroke.
other contraceptive choices for women over 40:
(long acting reversible contraceptives): LARCs provide birth
control for long periods of time and include intrauterine
devices (IUDs) and implants. "The American College of
Obstetricians and Gynecologists highly recommends LARCs for
women of all ages who donít want to think about taking a
pill every day," said Casey. Itís whatís known as the
forgettable option that works (except the copper IUD) by
thickening cervical mucus and keeping the lining of the uterus
thin, so itís less likely that an egg can be fertilized by
IUDs are small, long-acting, T-shaped plastic devices that are
inserted into the uterus to prevent pregnancy and can remain
in place for several years. In the U.S., two kinds are
available: the copper IUD that contains no hormones and
hormonal IUDs. The World Health Organization cites the failure
rate of the IUD at less than 1 percent. "Over 10 percent
of U.S. women using contraceptives now choose to use an IUD
because itís safe, easy to use and has few negative side
effects," said Dean.
The implant is a plastic tube about the size of a small
matchstick thatís inserted into the skin of a womanís
upper arm and can remain in place for up to three years. It
releases the hormone progestin into the body to prevent egg
fertilization and is safe, effective and convenient.
"Implants work well for women needing contraception
during the menopause transition," said Casey.
patch and the ring: The estrogen and progestin hormones in the
patch and the ring prevent eggs from leaving the ovaries and
thicken cervical mucus to block sperm from reaching an egg. A
patch has to be affixed to the skin once a week for three
weeks and removed for the fourth week. A ring has to be
inserted in the vagina for three weeks and also removed for
the fourth. "Both alternatives have similar advantages
and disadvantages as the pill, though the patch has been
linked to a slightly higher risk of blood clots and is
generally not a top choice for menopausal women," said
The birth control shot is an injection of progestin into the
arm or buttocks. To prevent pregnancy, it requires a new
injection every three months to stop ovaries from releasing an
egg and to thicken cervical mucus to block sperm. The shot,
said Dean, is effective and safe and can be used even by women
who smoke or have health issues.
methods: The diaphragm, cervical cap, male and female condoms,
and spermicidal foams and sponges are all barrier methods that
must be put in place before sexual intercourse and remain
there for specified amounts of time to block the opening of
the uterus and prevent sperm from fertilizing an egg.
"Methods that require a lot of attention on the part of
the user, like barrier methods, have the highest failure
rates, because itís hard to be motivated to use them with
every act of intercourse," said Dean. Condoms, however,
are a great way to protect against infection.
1970s, the U.S. Food and Drug Administration recommended that
women over 35 stop taking the birth control pill. It was
widely believed that the pill increased the risk of heart
disease. But now weíve learned that the risk is mostly for
women who smoke. Additionally, the amount of estrogen used in
the pill has dropped significantly, and with that drop, so has
the risk of health complications.
menopausal women, the pill can help with controlling irregular
bleeding, lessening hot flashes, maintaining bone density, and
lowering the risks of uterine and ovarian cancers.
perimenopausal women make birth control decisions, I encourage
them to think about whether or not they wish to get pregnant,
how disruptive an unplanned pregnancy would be and to discuss
with their health care provider any health issues that affect
contraceptive choices," said Casey. "The best option
for each woman is an individual choice."