Women of older reproductive age can now safely choose oral contraceptives or an Intrauterine Device (IUD) for contraception, according to a paper published in the March issue of The New England Journal of Medicine.
The review was written by Andrew M. Kaunitz, M.D., a UF College of Medicine-Jacksonville professor of obstetrics and gynecology. Kaunitz presented formal guidelines, evidence supporting current strategies, and provided clinical recommendations for hormonal contraception in women of older reproductive age. In his article, he stated that lean, healthy, non-smoking women over 40 can safely use oral contraceptives into their mid 50s. This age group also has lower rates of contraceptive failure than do younger women.
“Healthy women who are non-smokers can take advantage of both the contraceptive and non-contraceptive benefits of the pill,” said Kaunitz. “Women over 40 who take the pill are less likely to experience symptoms that are commonly associated with menopause such as hot flashes, night sweats, and irregular menstrual bleeding. The pill also reduces hip fractures and ovarian cancer.”
Kaunitz goes on to say that there is often misunderstanding about the use of oral contraceptives not only among patients but also physicians. He said many physicians do not believe women can safely remain on the pill beyond age 40. His review states that contraceptives containing a lower dosage of estrogen are increasingly prescribed for women of older reproductive age. Women who use low-estrogen oral contraceptive formulations have at least a 50 percent lower risk of developing epithelial ovarian cancer than women who have never used these formulations.
Oral contraceptives are not appropriate for all women over 40, especially those who are obese, smoke or have migraine headaches. These factors may increase the risk of developing blood clots, heart attacks or strokes. In addition, as some women approach menopause, they may develop health complications such as obesity, diabetes and hypertension. In these instances, women should consider an alternative method of contraceptive such as the IUD. Kaunitz said the IUD, which is widely used in Europe, is becoming more popular in the United States.
Kaunitz said there are two myths that are commonly associated with women over 40 taking oral contraceptives. The first myth is that the pill increases a woman’s chance of developing breast cancer.
“The pill does not elevate the risk of breast cancer,” said Kaunitz, citing The Women’s Contraceptive and Reproductive Experiences (CARE) Study.
The second myth is that women in their 40s are too old to take the pill.
“I keep my lean, healthy, non-smoking patients on the pill until their mid-50s,by that time they no longer need birth control,” said Kaunitz. “At that point the patient can come off the pill.”
A third myth addressed by Kaunitz in a separate investigation was the use of over-the-counter herbal supplements such as soy and black cohosh that many women use to treat hot flashes themselves.
“As I tell my patients, I wish non-hormonal, non-prescription treatments were effective, but they are no more effective than a placebo,” said Kaunitz.
While there are health risks associated with taking the pill, Kaunitz believes it is safe, effective and the answer many women over 40 are looking for to prevent unplanned pregnancies, with the added benefit of reducing menopausal symptoms.