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If you’ve recently celebrated a milestone birthday, have you given any consideration to the type of birth control you’re using?
In general, birth control for women over 40 is not much different from birth control for women over 35. If you’re happy with the current method of contraception that you’ve been using, and you’re in good health overall, there’s really no reason to switch just because there’s another candle on your birthday cake.
“There is nothing about age alone that says you can’t use a particular kind of birth control,” explains Kate White, MD, MPH, director of the Fellowship in Family Planning at Boston Medical Center. “If you are healthy at any age, you can use anything.”
Some of your choices include:
- Birth control pills: You can take a combination pill, which contains both estrogen and progestin, or a progestin-only pill. Both come in low-dose versions, and combination pills also come in extended-cycle versions.
- IUDs: Intrauterine devices are a popular form of long-acting reversible contraceptive, or LARC. Some, like the Mirena or Liletta IUDs, are hormonal forms, while others, like the Paragard IUD, are copper.
- Injections: If you choose the birth control shot, called Depo-Provera, you receive an injection of progestin every three months to prevent pregnancy.
- Implants: Another long-acting reversible contraceptive, the implant releases progestin into your body for three years from its place in your upper arm.
- The patch: Stick on your skin for three weeks, then remove. Apply a new one each month.
- Vaginal ring: These are flexible, removable rings that contain both estrogen and progestin.
But one thing you can’t afford to do is to ignore the whole issue. “Don’t give up on the conception until you know you’re fully menopausal,” says Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology and reproductive sciences at the Yale University School of Medicine.
That means you need to go for an entire year with no menstrual periods before you bid farewell to birth control for good.
Look at your own risk profile
As you weigh your options, there are some health issues to consider, in your late 30s and throughout your 40s. What do you need to think about when choosing a contraceptive method? You need to weigh health-related risks of contraception against the increased risks associated with a pregnancy after 35—including an unplanned pregnancy, says Wendy Askew, MD, an OB-GYN in San Antonio, Texas. These risks exist for women under age 35, too, but are much lower.
Smoking
If you’re 35 or older and you smoke, it’s time to bid farewell to your birth control pills. Smoking raises your risk of cardiovascular disease anyway. But the combination of hormonal birth control and smoking can increase your risk of blood clots and high blood pressure.
Blood clots
If you are at increased risk for certain conditions like blood clots, your doctor may steer you away from certain contraceptive options. For example, combination birth control pills contain both estrogen and progestin and may raise your risk for developing blood clots. The birth control injection known as Depo-Provera is better known for being linked to an increase in bone loss over time. It does not contain estrogen, but some women may develop thrombosis after taking it.
Certain health conditions
You might also want to avoid methods containing estrogen if you have high blood pressure, or if you’ve had diabetes for at least 20 years. Migraine headaches with aura might be another possible contraindication, says Dr. White.
Cancer
The risk of developing cancer, however, is murky. Your risk of developing cancer increases with age. There may be a small possibility of an increased risk of breast cancer associated with some oral contraceptives, but it may be offset by a reduced risk of other types of cancer, like ovarian and uterine cancer. And as Dr. Askew notes, the benefit of preventing an unwanted pregnancy may very well outweigh the slight risk. Women with a family history of a particular genetic mutation for breast cancer could still consider looking at other options, though.
Choosing the best birth control method
In your late 30s and 40s, you should ask yourself—and be honest about the answer—if you are planning to have any children in the future.
- Yes, I am planning to have children. If the answer is yes, you can go with just about any method, except Depo-Provera. According to Dr. White, it can take a while for your fertility to return after going off Depo-Provera, and if you’re in your late 30s or 40s, you don’t have a lot of time to spare.
- Maybe I will have children. “If you think so, IUDs and implants can be great because it can give you years of not having to think about birth control while still reserving the option, in case you’re not 100% sure,” says Dr. White.
- No, I do not plan on having children. “If you know you are done having kids, think about [surgical] sterilization,” suggests Dr. White. However, if you and your partner don’t want to go that route, you can continue using a pill, a LARC, or other method, as long as you don’t have any health issues that would be problematic.
Birth control for women over 40 can help you manage symptoms of perimenopause that you’re experiencing. Talk to your doctor if you’re concerned about symptoms like hot flashes, night sweats, and vaginal dryness and discuss what methods might be best for you. If you don’t have any contraindications, a method containing estrogen, like a combination birth control pill or ring, might help you manage some of those symptoms, notes Dr. Minkin. And if you’re involved with a new partner, don’t forget to use condoms—you can get a sexually transmitted infection at any age.
Keeping your options open
Based on your health or other needs, some birth control options may be better than others for you in your 40s and 50s. Plus, new ones may be in the works. “It’s always good to re-evaluate because there are always new developments that come on the scene,” says Dr. Minkin.
For example, the U.S. Food and Drug Administration approved a new vaginal ring called Annovera in 2018. Unlike NuvaRing, the other vaginal ring on the market, it can be used for an entire year. You still have to remove it each month, but you don’t have to get a new one each month from the pharmacy.
And don’t be afraid to try something else if your current method doesn’t work for you and your particular needs. “It’s trial and error with birth control,” Dr. Askew says.
