Birth control is an important decision every woman needs to consider. But if you're over the age of 40, the rules are different than they are for younger women. Dr. Laurie Green of the Pacific Women's OB/GYN Medical Group in San Francisco visited us to help break down the pros and cons.
Birth control over 40:
Yes, you do NEED it. Among fertile women, 50% can conceive spontaneously at age 40, 10% at age 46
New ideas:
'B7It's not your mother's birth control pill any more: very low dose BCPs are safe for healthy non-smokers until menopause, and often help mitigate PMS, which increases in severity for some women with age. They also limit menstrual flow, which can also increase with age. Birth control pill use for 15 years or more cuts the lifetime risk of ovarian cancer in women in half! Some pills result in periods quarterly, and one provokes a single period per year. Heavy set women, those with a history of high blood pressure, diabetes, or migranes cannot use the usual pill. Progesterone only birth control pills may be of use in those women.
IUDs rock: the Dalkon Shield IUD, which led to pelvic infections, has gone the way of the model T. The Mirena IUD, a progesterone-coated device, lessens menstrual flow and helps some women avoid surgery. Good for 5 years. The copper paragard, good for 10 years
Birth Control in a Ring: Nuvaring: this goes in the vagina and contrary to what many patients would suppose, is as effective in preventing pregnancy as the pill. It stays in place for 3 weeks, comes out for 1 week (period comes), and doesn't have to be placed as precisely as the diaphragm or cervical cap. Given that it also contains estrogen and progesterone, the same precautions should apply as for standard pills.
Tubal ligations that really ARE minor surgery: previously, tubal ligation could be performed through the laparoscope, but still required a trip to the hospital, deep general anesthesia and surgical risk. Today, plugs can be placed into the tubes via the vagina with a procedure known as hysteroscopy. These can be office-based procedures and are tolerated with mild sedation
As a last resort: the morning after pill: This is the equivalent of taking 4 low dose birth control pills twice over an interval of 24 hours. Not the best choice, but okay in healthy, non-smoking women. The old standbys
The sponge is back!
Condoms & diaphragms do work...provided they are properly used
Rhythm is risky over 40: many women in their 40s begin to ovulate earlier in the menstrual cycle, ie, day 7-12, not day 14, and since sperm can live up to 4 days, it isn't worth the risk!
Depo-Provera: A shot of progesterone given every 3 months; probably not the best choice for older women as longterm progesterone can cause some thinning of the bones and there is still controversy over the role of progesterone in breast cancer causation
Pills: Standard pills contain both estrogen and progesterone in low doses. The estrogen dose is at least 50% less than what it was in the 70s and even the 80s, and with the lowered doses, the side effects are less. Pills not only provide superb birth control, but also longterm pill use (10-15 years) cuts the ovarian cancer risk in half (1.2 to .6% lifetime risk); the uterine lining cancer risk in half, and even lowers the colorectal cancer risk slightly. We believe these benefits may last up to 3 decades after the pill is stopped, but all the more reason to use in your 40s as all of these cancers increase in frequency with age. Several studies from around the world involving tens of thousands of women indicate NO increased risk of breast cancer from pill use, even in women carrying the so called BRCA gene. Bone density seems to be enhanced by the pill too. And, of course, heavy periods stop when the pill is used. The normal menstrual cycle length in women in their 40s is 21-24 days, so the pill stretches the cycles out longer (28 days) and lessens the flow. In addition to flattening out PMS and improving the skin, pills do not cause weight gain and do smooth out perimenopausal symptoms...so in lean, healthy, non-smoking women without any underlying cardiovascular disease, the pill can be used into one's 50s. Who should avoid the pill? Smokers over 35, women with diabetes, high blood pressure, or migraines, and women with a history of blood clots in legs or lung. Those women may still be able to take progesterone only pills.
