Women over 40 need to be vigilant about contraception even in perimenopause

Women reaching the age of 40 tend to be less vigilant about birth control because they think the risk of pregnancy is low - or that birth control can cause health problems - but a review of the evidence by a team that includes a Women & Infants Hospital of Rhode Island physician recently underscored the need to be vigilant about contraception even in perimenopause.

"Despite declining fertility, women over age 40 still require effective contraception if they want to avoid pregnancy," according to Rebecca H. Allen, MD, MPH, of Women & Infants' Department of Obstetrics and Gynecology Division of Research. "In addition, the benefits of birth control outweigh the risk. Even for women with risk factors, there are methods that can be safely used."

The research, entitled "Contraception in women over 40 years of age," was published recently in the Canadian Medical Association Journal (CMAJ). The goal is to educate women and help physicians find the best methods of contraception for their patients.

Women over 40, Dr. Allen explains, need to talk with their primary care provider about which choice of contraception is best for them given their health. Even if they've used a specific method in the past, it might be less appropriate now because of other medical conditions.

Contraception should be used until a woman is assured she has gone through menopause, she adds. Menopause can be assumed after a woman age 50 or older has no menstrual cycle for a year.

In addition to helping to prevent pregnancy, women can find relief from some perimenopausal symptoms with the right contraceptive. This includes:

• Estrogen-containing oral contraceptives or the progestin-releasing intrauterine device for help stemming the heavy menstrual bleeding that can occur in the perimenopause
• Estrogen-containing contraceptives can help vasomotor symptoms such as hot flashes and night sweats
• Estrogen-containing oral contraceptives might possibly prevent declines in bone density, according to one study
• Combined oral contraceptives decrease a woman's risk of developing endometrial cancer by 50%, according to the results of two large studies