Contraception for Midlife Women: A Review

Taniqua A. Miller, MD; Rebecca H. Allen, MD, MPH; Andrew M. Kaunitz, MD; Carrie A. Cwiak, MD, MPH

Disclosures

Menopause. 2018;25(7):817-827. 

In This Article

Abstract and Introduction

Abstract

Family planning represents a key component of reproductive health care. Accordingly, the provision of contraception must span the reproductive age spectrum, including perimenopause. The risk of pregnancy is decreased, but not trivial, among women over 40 years of age. Evidence-based guidelines for contraceptive use can assist clinicians in counseling their patients in this population. Intrauterine contraception is one of the most effective methods and is safe to use in midlife women with few exceptions. Progestin-only contraception is another safe option for most midlife women because it is not associated with an increased risk of cardiovascular complications. Combined (estrogen-containing) contraception can be safely used by midlife women who do not have cardiovascular risk factors. Unique noncontraceptive benefits for this population include: improvement in abnormal uterine bleeding, decreased hot flashes, and decreased cancer risk. Finally, guidelines state that contraception can be used by midlife women without medical contraindications until the age of menopause, at which time they may consider transition to systemic hormone therapy.

Introduction

Family planning represents a key component of reproductive health care: since the average woman in North America desires two children, she will spend about 3 years pregnant, postpartum, or attempting to become pregnant, and over 30 years trying to avoid pregnancy.[1] Accordingly, the provision of contraception must span the reproductive age spectrum, including perimenopause. In this article, we review the need for contraception among women over 40 years of age and present evidence-based guidelines for contraceptive use in this population. We detail the contraceptive options available to women over 40, and also the unique contraceptive and noncontraceptive benefits and health risks associated with contraceptive use in this population. Finally, we assist clinicians as they provide guidance for women transitioning from contraception to their menopausal years, including possible initiation of systemic hormone therapy (HT).

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....