HealthAgenda

As you get older your health risks and hormones change. If you’re a woman over 40, you may want to review your contraception. Here are some worth considering.

Karen Burge
February 2019

Your fertility might decline after 40 but that doesn’t mean birth control should slip off your radar.

The contraceptive(s) that worked for you in your 20s and 30s might not be as appropriate now, as your risks of heart disease, diabetes, cancer and bone fracture increase. So it’s an ideal time to rethink your birth control.

All contraceptives have pros and cons so it’s wise to speak to your GP about what would work for you. If you want more information, credible sources include Family Planning NSW and Jean Hailes for Women’s Health.

Here are a range of options, and because it takes two, we haven’t forgotten the men.

Implants

Intra uterine device (IUD) plus progestogen (Mirena)

This small plastic device contains a very low dose of slow-releasing progestogen and is inserted into the uterus to prevent pregnancy. It thickens the mucus of the cervix to stop sperm from reaching the uterus. Often periods become much lighter, or even stop, as a result.

“Most of the action is in the lining of the uterus – not much is absorbed and goes around the rest of the body,” explains Dr Amanda Newman, women’s health specialist GP with Jean Hailes for Women’s Health.

“If you have a Mirena inserted after the age of 45, you can leave it there for the next 10 years.” Before that, it’s recommended you change it after 5 years.

This and other long acting reversible contraception (LARCs) can be good for older women, because they don’t carry the same risks as oestrogen-containing options like the combined pill (see below).

Being a longer term solution, it can also be more convenient, and in some cases more effective (check the stats for each method before making a decision).

Copper IUD

Another LARC, the copper IUD is also inserted inside the uterus. It’s hormone-free and has copper wire wrapped around its stem, preventing a fertilised egg from settling in the uterus. It also creates an unfriendly environment for sperm.

It’s suitable for women who need to be hormone-free (such as those with a history of breast cancer) or who choose to be, says the medical director of Family Planning NSW Dr Deborah Bateson.

The downside is that periods can become heavier and last longer.

Progestogen implants (Implanon)

A flexible rod is inserted under the skin in your arm, where it continuously releases a low dose of a progestogen into your blood over 3 years (making this another LARC).

Some women with this implant have no or light menstrual bleeding, and it may also reduce premenstrual syndrome.

Oral

The pill

The combined oral contraceptive pill stops the ovaries from releasing an egg each month, preventing pregnancy. But you do have to remember to take it every day.

Dr Newman says that for somebody in good health, the pill is fine up until the age of 50. But “women who are high risk of heart disease – and that means women who are overweight, have high blood pressure or who smoke – shouldn’t be on the pill,” she says.

Women over 35 who smoke and take the pill are at greater risk of heart attack and stroke. If you have diabetes, the pill can also increase your risk of complications.

The mini pill

The mini pill, or progestogen-only pill, contains only a low dose of progestogen and is very effective in women older than 40 as fertility naturally declines. The mini pill has to be taken at the same time every day – within a narrow timeframe of 3 hours.

“While it may suit some women, many patients I see prefer a longer-acting method which doesn’t rely on remembering to take a pill every day,” Dr Bateson says.

Surgery

Tubal ligation

Some women in their 40s consider tubal ligation if they’re certain they don’t want to have any, or more, children. It’s a permanent method of contraception.

Tubal ligation involves keyhole surgery in your lower abdomen which means a general anaesthetic. Clips are put on your fallopian tubes to block sperm from reaching an ovum (egg). There are small risks your doctor can discuss.

Vasectomy

A vasectomy is an operation for men to cut the tubes that carry sperm from the testes. About 1 in 4 men over the age of 40 have had a vasectomy, according to Andrology Australia. If you’re considering this option, ask your GP for a referral to a specialist.

Barrier contraception

Condoms

Condoms reduce the chance of unplanned pregnancy and the risk of contracting a sexually transmitted infection. But they’re not as effective as some other methods in preventing pregnancy – just 82–98%. Condoms can be combined with other methods of contraception, including the pill, injections, implants and IUDs.