Eggs in the ovaries become older and their quality diminishes. If one does get pregnant, the chance of miscarriage is much greater than earlier in life. However, most women in this age group have left child-bearing years behind them. But even though fertility is reduced, women still want safe birth control to avoid any chances of a possible unwanted pregnancy with all the associated negative consequences.
Unfortunately, there are no simple tests available to find out how many “good eggs one has in the bank.” It also isn’t easy to determine when the egg reserves in the ovaries are depleted so that it is easier to choose the best contraceptive.
Textbooks recommend birth control for up to a year after a woman’s last menstruation. At the time of menopause, it is believed that there are still about 1000 immature egg cells in the ovaries which at least theoretically could cause pregnancy. In reality, the ability to carry a child full term is strongly reduced from 42 to 43 years of age.
None of today’s birth control options are unsuitable or harmful to use for women over 40, but it is important to be sure that one isn’t considered to be in a risk group.
Normal birth control pills (combined pills) which contain both oestrogen and progestogen are safe and sure prevention which can be used well up to menopause. Previously, there was some scepticism around this, but as long as the pills are taken by healthy, average-weight, non-smoking women who have no known tendencies towards illness, it is today consider to be okay.
One shouldn’t take birth control pills in her forties IF she:
• experiences migraines
• had diabetes
• has had blood clots (thrombosis/embolism) or if there is known tendencies towards this
• has an active liver disease
• has cardiovascular disease
• has malignancy in the breasts or uterus
It is worth noting that birth control pills can also have positive benefits unrelated to preventive measures for women in their 40s:
• menstruation becomes more regular, often with less pain and flow
• can mask signs of menopause such as night sweats and hot flashes
• can maintain bone density to certain degree
Birth control pills contain synthetic oestrogen which differs from hormonal treatment during menopause which includes “natural” oestrogen, that is oestrogen which is a chemical equivalent to the body’s own.
There isn’t one or several birth control pills more suitable than the others for women in their 40s, but the newest and lowest doses of oestrogen are more surely used by younger women.
Hormonal treatment for hot flashes is not a birth control measure.
As for a vaginal ring and birth control patches, the same factors hold true as for birth control pills. Combinations of oestrogen and progestagen are the same, though the levels of oestrogen are less in the vaginal ring.
Mini-pills are also fine to use as birth control for 40 plus. They contain only the one hormone progestagen and not oestrogen, and must be taken every day. Previously, there were only mini-pills with a three-hour ‘time limit’ of taking them on a daily basis but now there is a newer and more practical alternative in which the mini-pill can be taken within a 12-hour limit.
Progestogen is also found in contraceptive injections which are injected into the buttocks every three months. After a few injections, many completely lose their menstruation as an expected effect. If one desires to become pregnant it is important to realize that it can take up to one and a half years to regain normal menstruation. Long-term use of contraceptive injections can also lead to a certain amount of reduced bone density, but this is a passing effect.
Contraceptive rods are also an alternative for those who wish a type of contraception they don’t have to think about. It is a small, matchstick-sized rod which with a simple procedure is inserted under the skin on the inner side of the upper arm and lasts for three years.
IUDs still popular
IUDs, whether it is a usual copper-based device or hormonally-based device (called hormonal uterine systems, IUS), are preferred by many women over 40. They are practical, easy, safe prevention.
The copper IUD is the world’s most common contraceptive. It is just a foreign body which is placed within the uterus without disrupting hormonal patterns. It is safe, inexpensive and simple. Side effects can include heavy, painful menstruation, but not necessarily. There is also a possible increased risk of infection.
The IUD can be left in place for at least five years, but also even longer if one is close to menopause and has no complications. The hormonal IUS has also gradually become very popular. It looks like a normal IUD but in addition includes a progestagen which is released a little bit every day during the five years the manufacturer guarantees for. It is used as both a means of birth control as well as to treat heavy, lengthy menstruation. The hormonal IUS also works well for women who have endometriose.
It can also be used by women who haven’t given birth. During the first three months, the hormonal IUS can cause frequent spotting which after awhile becomes less and seldom. About 20 percent lose menstruation completely for a time. When the IUD is removed, a woman quickly resumes her regular cycle again. The hormonal IUS can be combined with oestrogen patches or tablets for symptoms of menopause when that time comes.
Classic contraceptives such as diaphragms and condoms can of course be used during the last ten years before menopause. The diaphragm has gradually become less popular than before, while many women in their forties tend to trust condoms after years of taking responsibility for birth control. There’s also nothing wrong in using morning-after pills as long as one can tolerate the oestrogen part.
Birth control pills or IUDs (Intrauterine Devices)