With increasing age, contraceptive needs and considerations evolve, especially for those over the age of 40. There is a natural decline in fertility yet women still require contraception until they reach menopause if they wish to avoid an unplanned pregnancy.  With changing lifestyles, career priorities, and family planning goals, 

In this article, we will explore various contraceptive options, taking into account the specific needs and health considerations of women over 40.

Hormonal Contraceptives YES YOU CAN 

Hormonal contraceptives are methods of birth control that use hormones to prevent pregnancy. These contraceptives typically contain synthetic versions of hormones such as oestrogen and progestin, which are naturally produced by the ovaries.

There are various forms of hormonal contraceptives, and they work by suppressing ovulation (combined hormonal contraception) or  thickening cervical mucus to impede sperm movement, and thinning the uterine lining to discourage implantation (progesterone only methods of contraception). 

Combined Contraceptive Pill (oestrogen and progestin) 

Birth control pills remain a choice for women over 40. However, it is essential to be aware of the potential risks associated with combined hormonal contraception, such as an increased risk of blood clots, especially for smokers or people with other cardiovascular risk factors. Women over 40 are often advised to opt for low-dose formulations. However, the combined pill may help with heavy periods (as in adenomyosis), hot flushes and maintain bone density in perimenopause.

Progesterone Only Pill (POP) 

The POP is available over the counter, however, the pharmacist will still need to make sure that there is no contraindication to deliver it.

Irregular bleeding is a common side effect of POP. This may make the management of abnormal bleeding more difficult as women may be either wrongly investigated or wrongly reassured.

Patch and Ring (Combined contraception: oestrogen and progestin) 

The contraceptive patch and vaginal ring are convenient alternatives to daily pills. These methods release hormones steadily, offering effective protection. 

Nevertheless, women over 40  should consult their healthcare provider to determine the most suitable option based on individual health factors. Prescribing should be guided by the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC).

Long-Acting Reversible Contraception (LARC)

Long-Acting Reversible Contraception (LARC) refers to a category of contraceptive methods that provide effective birth control for an extended period without requiring user intervention on a daily or regular basis. LARC methods are highly reliable and suitable for individuals who want a long-term solution for preventing pregnancy. There are two main types of LARC methods:

Intrauterine Devices – Copper Coil (IUD) and Hormonal Coil (IUS) 

IUDs, commonly known as the coil, are highly effective, long-term contraceptive options for women over 40. The T-shaped birth control device is inserted into the uterus to prevent pregnancy. They come in hormonal and non-hormonal varieties, providing flexibility based on personal preferences and health considerations. 

The Hormonal coil Mirena is licensed for contraception and endometrium ( lining of the uterus) protection in perimenopause and menopause when oestrogen supplementation (HRT) is needed. 

Implants

Contraceptive implants, such as Nexplanon, are a discreet and long-lasting option. Placed under the skin, they release hormones to prevent pregnancy. While generally safe for women over 40, a healthcare provider should evaluate individual health factors.

Barrier Methods

Barrier methods of contraception are contraceptive methods that physically block sperm from reaching an egg, thus preventing fertilisation. These methods are generally considered reversible and do not involve the use of hormones.

Male Condoms

These are thin sheaths made of latex, polyurethane, or polyisoprene that are worn over the penis to prevent sperm from reaching the egg.

Female Condoms

These are pouch-like devices that are inserted into the vagina to prevent sperm from entering the uterus.

Intrauterine Devices (IUDs)

Copper IUD: This type of intrauterine device is inserted into the uterus and releases copper, which is toxic to sperm. It prevents fertilisation and may also prevent implantation.

Natural Methods

Natural methods of contraception, also known as fertility awareness methods or natural family planning, involve understanding and tracking a woman’s menstrual cycle to identify fertile and infertile periods. It’s important to note that these methods are less effective than some other forms of contraception, such as hormonal methods or barrier methods, and they require careful attention and consistency.

Fertility Awareness-Based Methods (FABMs)

These methods involve tracking and charting a woman’s menstrual cycle to identify fertile and non-fertile periods. This includes methods such as the calendar method, temperature method, and cervical mucus method.

Withdrawal (Pull-out) Method

This method involves the man withdrawing his penis from the vagina before ejaculation to prevent sperm from entering the woman’s reproductive tract.

Barrier Methods Combined with Spermicide
Using barrier methods, such as condoms, along with spermicidal agents can provide an additional layer of protection by killing or immobilising sperm.

Permanent Methods

Permanent methods of contraception are surgical or procedural interventions that aim to permanently prevent pregnancy. These methods are considered irreversible, and they are typically chosen by individuals or couples who have decided not to have any more children.

Tubal Ligation (for women)

Also known as “getting your tubes tied,” tubal ligation involves blocking or sealing the fallopian tubes, which are the pathways that carry eggs from the ovaries to the uterus. This prevents sperm from reaching the egg and fertilising it. There are different methods of performing tubal ligation, including cutting, tying, or sealing the tubes. This procedure is usually done through laparoscopic surgery.

Vasectomy (for men)

Vasectomy is a surgical procedure that involves cutting or blocking the vas deferens, the tubes that carry sperm from the testicles to the urethra. By interrupting this pathway, sperm is prevented from being released during ejaculation. Vasectomy is a relatively simple and quick procedure that can often be done in a doctor’s office under local anaesthesia.

Considerations for Women Over 40

For women over the age of 40, contraception considerations often involve a balance between preventing unintended pregnancies and addressing potential health risks associated with age. Symptoms of perimenopause may start and may need treatment. 

Health Assessment

Women over 40 should be informed of the age-related increased background risk of cardiovascular disease, obesity and of breast and most gynaecological cancers.

Women over 40 should undergo regular health assessments, including blood pressure checks, breast examination, cervical smears as well as diabetes and cholesterol screening, as hormonal contraceptives may impact cardiovascular health.

Smoking and Contraception

Smoking increases the risk of cardiovascular issues and blood clots, especially for women over 35. It’s crucial to discuss smoking habits with healthcare providers when considering hormonal contraceptives.

Family Planning Goals

Women in this age group often have specific family planning goals. Discussing long-term plans with a healthcare provider can help tailor contraceptive choices to align with individual needs.

Navigating contraceptive choices for women over 40 involves careful consideration of health factors, lifestyle, and family planning goals. From hormonal options to long-acting reversible contraception and non-hormonal methods, the key is to consult with a healthcare professional to determine the most suitable and effective contraceptive strategy for each individual.

Making informed decisions empowers women to take control of their reproductive health and live life on their terms. Contact us today to discuss your options.

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