Contraception Options For Women Ages 40, Older Expanding

Main Category: Sexual Health / STDs
Also Included In: Women's Health / Gynecology
Article Date: 09 Apr 2008 - 8:00 PDT

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Women ages 40 and older have more contraceptive options than in previous years, during which their contraceptive options were often limited to tubal ligation surgery and condoms, the AP/Google.com reports. According to the AP/Google.com, women ages 40 and older are a "complex group" in terms of contraception because some have had several children and are willing to undergo tubal ligation surgery, but others might want children at some point. Such women are the least likely age group to use contraception, contributing to the highest abortion rate along with adolescents, the AP/Google.com reports.

Tubal ligation for women and vasectomies for males remain the most common forms of contraception for women 40 and older. Physicians are increasingly offering a type of nonsurgical tubal ligation called Essure, which was approved by FDA in 2002. Rather than cutting through the abdomen to cut and tie the fallopian tubes like in traditional tubal ligation surgery, physicians performing the new procedure use a thin tube to thread small devices into the fallopian tubes through the cervix. The devices cause sufficient scarring within about three months to prevent eggs from reaching the uterus.

The New England Journal of Medicine on March 20 published a report on contraceptives for women older than 40 by Andrew Kaunitz of the University of Florida. In the review, Kaunitz said that although the risk of blood clots increases at age 40 among women taking oral contraceptives that contain estrogen, current oral contraceptives have lower doses of estrogen than earlier pills and are safe for lean, healthy older women. Some older women might prefer oral contraceptives because they can control irregular menstrual bleeding and hot flashes and have been found to reduce hip fractures and ovarian cancer, Kaunitz -- who has received fees and grants from companies that manufacture oral contraceptives -- said.

Experts said that physicians should suggest that older women who are obese, smoke or have migraines, high blood pressure or other risk factors use progestin-only oral contraceptives or intrauterine devices. Although studies have found higher breast cancer rates in older women who take hormone replacement therapy for menopause symptoms, studies have not found an increased risk of breast cancer among women older than 35 who take oral contraceptives.

Another contraceptive option for women ages 40 and older is a small plastic rod called Implanon that is placed under the skin of the upper arm (Stobbe, AP/Google.com, 4/5). The device, which was approved by FDA in 2006, releases progesterone, inhibiting pregnancy for up to three years or until the device is surgically removed (Daily Women's Health Policy Report, 7/18/06).

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