References
Contraception for women aged 40 and over
Abstract
Although fertility naturally declines with age, women who do not wish to become pregnant require contraception until menopause. The safety profile for contraception in women over 40 is different to that of younger women, due to an increased background risk of co-morbidities such as venous thromboembolism, osteoporosis and breast cancer. Conversely, contraception may alleviate or mask symptoms of perimenopause, such as vasomotor symptoms or problematic periods, conferring additional non-contraceptive benefits to women in this age group. For these reasons, the risk-benefit ratio for women over 40 using contraception is different to that of younger women and requires specific consideration when working with women to choose a suitable method of contraception.
Despite fertility naturally declining with age, women require effective contraception until menopause in order to avoid unplanned pregnancies. Although there is a trend towards women having children later in life, there are also a number of unplanned pregnancies in women over 40 and the abortion rate for this group of women continues to rise (Department of Health and Social Care, 2018). For women over 40, pregnancy is associated with higher rates of maternal morbidity and mortality, significantly increased rates of miscarriage and ectopic pregnancy, and increased rates of pre-term delivery, stillbirth, perinatal mortality and congenital anomalies (Faculty of Sexual and Reproductive Healthcare (FSRH), 2017a).
As with all women, a contraceptive discussion needs to take into consideration a woman's medical history, personal preferences and any non-contraceptive benefits; but women aged over 40 have additional considerations. Due to increasing morbidity with age, background risks are higher than for younger women and so contraceptive safety profiles also differ.
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