Contraception for the older woman
Bowen-Simpkins, P.
British Journal of Obstetrics and Gynaecology 91(6): 513-515
1984
ISSN/ISBN: 0306-5456 PMID: 6733055 DOI: 10.1111/j.1471-0528.1984.tb04795.xDocument Number: 425037
This paper discusses the dilemma faced by older women in finding a method of contraception that is both safe and effective. For normotensive, slim women over 35 years of age who have never smoked, combined oral contraceptives (OCs) still provide a viable method of fertility control. However, there is a 2-3-fold increased risk of mortality from cerebrovascular and preipheral vascular disease among OC users who smoke. The progestagen-only pill is free of adverse cardiovascular effects but may produce irregular menses and intermenstrual bleeding. Depo-Provera has been used in older women as a shortterm method of contraception and menstrual regulation. An investigation of the effects of estradiol implants in premenopausal women produced excellent results both in amelioration of incidental symptons and as a contraceptive, although a more extensive trail is needed. Since the risk of pelvic inflammatory disease is low amoung older multigravid women, the IUD is an attractive contraceptive alternative. Vaginal laxity and cervical deformities resulting from childbirth may reduce the efficiency of the diaphragm. Sporadic ovulation and unpredictable menstruation make natural or rhythm methods of fertility control inappropriate for older women. Female laparoscopic sterilization is becoming increasingly acceptable among women in this age group. Overall, the scope and choice of contraceptive methods available to women over 35 years of age is expanding.