Birth control choices are wider these days for women 40 and older — a group that once viewed its options as pretty much limited to tube-tying surgery and condoms. For them, the pill is back. So is the IUD. Both are safer than they used to be. There's even a nonsurgical method of tube-tying.
This variety of methods has long been needed, experts say, because 40- and 50-somethings are a complex group. Some have had several children and are willing to have sterilization surgery. Others may want children, but not right now.
Traditionally, women 40 and older are the least likely to use birth control. Along with adolescents, they have the highest rates of abortion. At the same time, these women are more experienced at using contraception and follow instructions better.
So, why the change? Mostly because medical advancements are giving all women more options, and making older methods of contraception safer.
A review of the current science of contraception and women 40 and older was published recently in the New England Journal of Medicine. The author, University of Florida gynecologist Dr. Andrew Kaunitz, noted that the risk of dangerous blood clots rises sharply at age 40 for women who take birth control pills containing estrogen.Most women who smoke or have medical conditions that make taking the pill risky aren't left out, though. Newer options for women over 40 also include IUDs (a small device inserted into the uterus), a progestin-only "mini pill" and Implanon (a small device inserted into a woman's upper arm).
The risk is even greater for overweight women, who also are more likely to have high blood pressure and diabetes.
But the dosage of estrogen in current birth control pills has been dramatically reduced. The pill is now considered a safe alternative for lean, healthy, older women Kaunitz and other experts said.
"It may not be well known that the current low-dose formulations are a reasonable option for healthy women in their 40s," said Dr. JoAnn Manson, a Harvard endocrinologist who wrote a book on menopausal hormone therapy.
The pill may be preferable for some women, because it can help control irregular menstrual bleeding and hot flashes and has been shown to reduce hip fractures and ovarian cancer, wrote Kaunitz. He has received fees or grants from several companies that make oral contraceptives.
The most common method of contraception for women over 40 is still sterilization, either by tubal ligation (for women) or vasectomy (for men). This method is permanent and extremely effective. It's therefore most popular among women over 40, who may have decided that they don't want to bear children, or who have decided that their families are complete. The good news is that even these options are expanding; in recent years, a non-surgical method of female sterilization has become available.
Increasingly, gynecologists are offering a newer type of tubal ligation that is nonsurgical. The procedure, called Essure, was approved by the government in 2002. Instead of cutting through the abdomen to cut and tie the fallopian tubes, a doctor works through the cervix, using a thin tube to thread small devices into each fallopian tube. These cause scarring, which in about three months plugs the tubes, stopping eggs from the ovaries from reaching the uterus.Among women aged 15-44 who have ever had sexual intercourse, 98% have used at least one contraceptive method, and 62% of American women in this age group are currently using a contraceptive method. Furthermore, a woman who wants two children will need to use contraception (or practice abstinence) for about 30 years (if course, the number of years is higher for women who want no children, and lower for those who want more). And since 80% of women will use the pill at some point in their lives, the popularity of other methods tells us that many women will use more than one form of contraception during their fertile years.
And that makes this good news for all women -- whether over 40-years-old now, or younger and looking to the future.
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