Contraception for Women Over 40: Expert Recommendations and Options

2023-10-29 18:00:00

In 2019, the National College of French Gynecologists and Obstetricians (CNGOF) published recommendations on contraception according to age. Indeed, depending on the moment in a woman’s life, contraception must be adapted. Particularly because of the risks associated with hormonal methods.

Even if the risk of spontaneous pregnancy within 12 months rises to 44% after the age of 40, it is important to maintain effective contraception. And “the assessment of risk factors must be even more rigorous to look for vascular and metabolic diseases, benign uterine and breast pathologies, while taking into account the sexuality and wishes of the patient,” indicates the CNGOF.

On the pill

After the age of 40, it remains possible to use estrogen-progestogen contraception, particularly the pill, but only if there are no vascular and metabolic risk factors. To ensure this, a metabolic assessment must be carried out 3 to 6 months after starting the contraceptive and the benefit-risk balance must be reassessed every year.

That being said, microprogestin contraception is better indicated at this age, because it does not present any contraindication on vascular, metabolic and bone factors. It therefore constitutes first-line contraception for women over 40.

However, it sometimes happens that it is poorly tolerated by some of them who will present with menometrorrhagia (bleeding of uterine origin) or signs of mastodynia (breast pain).

The IUD

The intrauterine device (IUD) – the IUD – is used by the majority of patients aged 40 to 49. It can be made of copper, for those who do not want hormones. However, “the existence of more frequent benign pathologies in those over 40 can lead to an increase in pelvic pain and menorrhagia” with the copper IUD, notes the CNGOF.

In this case, “the levonorgestrel IUD is effective and well tolerated, it may be indicated when the patient presents with dysmenorrhea and/or menorrhagia and/or adenomyosis*”. Not to mention that it does not influence arterial and venous vascular risk, nor bone mineral density.

If you are in this case, ask your doctor or gynecologist for advice, who will adapt the solution to your particular case.

*condition characterized by the proliferation of the endometrium inside the uterine muscle

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