Effective Contraception in Women over Forty: Risks and Benefits of Various Contraceptive Options

Ovarian activity decreases, menstrual cycles are disrupted and fertility declines in women over 40 years old. Although the risk of conception gradually diminishes, it does not disappear. Women in older ages have to use an effective contraceptive method in order to avoid unwanted pregnancies. The frequency of sexual intercourses, sexual problems, non-contraceptive benefits, menstrual irregularities and health status of women will have an influence on selection of contraceptives.
Age alone is not a contraindication for any contraceptive methods. Before a combined hormonal contraceptive is initiated, women should be exposed to a complete examination and those with obesity, migraine or hypertension and smokers should not be offered combined methods. Combined hormonal contraception can be recommended to perimenopausal women since it treats vasomotor symptoms, protects against bone losses, reduces the risk of some cancers and treats heavy menstrual bleeding. Perimenopausal women with excessive menstrual bleeding are recommended progestin-only intrauterine devices after abnormal vaginal bleeding is excluded. Many perimenopausal women use barrier methods with confidence and good adherence. However, male condoms, a barrier method, may create problems for couples when male partners have erectile dysfunctions. In such cases, another barrier method, female condoms can be preferable.
Perimenopausal women need contraception counseling so that they can select an appropriate contraceptive method. They should be informed about the time to give up contraceptive methods during contraception counseling.