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There's no question that 40 is a milestone birthday. It's a midlife point—a time to reflect, evaluate, consider, think. Is this the right career for you? Are you happy in your marriage or relationship? How are your children turning out? Is it time to have children?

But as you muse upon the course your life has taken up to now and where you want it to go over the next decade, don't forget to consider one very important component: Contraception. Whether you're finished having children or considering having your first one (don't laugh: in 2005, the birth rates for women 35 and older rose to levels not seen in almost 40 years), the only thing standing between you and the unexpected is your contraception.

Because while you may be moaning about your first gray hairs and the fact that it's suddenly become harder to lose those final (or first) five pounds and you've started paying as much attention to your retirement fund as to your kids' college fund, the reality is that some things really haven't changed very much. We're talking about your fertility—your ability to become pregnant. Yes, it's true that fertility declines with age. However, up to 80 percent of women between 40 and 43 can still get pregnant. In fact, your fertility doesn't end totally until you reach menopause—the day you've gone 12 consecutive months without a period.

Unfortunately, this is a fact that many women your age don't know. One study found that women in their late 30s and early 40s who were still sexually active thought that if they didn't get pregnant, they were infertile. Nope. They were just lucky.

In another study of 55 women with a median age of 72, just 55 percent said their doctor ever discussed sex with them once they turned 40. You can bet that if their doctors weren't talking to these women about sex, they probably weren't talking to them about contraception either.

All of which leads to the somewhat scary statistic you need to know: 29 percent of pregnancies in women 35 to 39 in the United States are unplanned, as are 38 percent of pregnancies in women 40 and older. Of those unplanned pregnancies, 56 percent end in abortion.

Bottom line: Even if you're finished with childbearing, you and/or your partner should take precautions to prevent pregnancy.

What to Use

By this point in your life, you've probably been through the contraceptive version of soup to nuts. Birth control pills, IUDs, condoms, jellies, and creams.

So now what do you do?

That depends on your answer to one question: Do you want more children?

If you answered yes, then you need reversible contraption. Your options include:

Birth control pills. Healthy women over 35 can safely use oral contraception, as long as they don't smoke, have normal blood pressure and have no history of cardiovascular disease. In fact, you can keep using it until age 50.

Rings and patches. Other estrogen-based birth control options include NuvaRing, which is inserted into the vagina like a diaphragm with a three-weeks-on-one-week-off schedule; and Ortho Evra, a skin patch embedded with hormones.

Progestogen options. These options include the injection Depo-Provera, the matchstick-sized rod Implanon and the IUD Mirena. All use the hormone progestogen to prevent pregnancy, and all can be used for months (Depo-Provera) or years (Implanon and Mirena).

Nonhormonal options. Copper IUDs, spermicides, the Today Sponge, diaphragms, cervical caps and condoms provide protection without hormones, but none are as effective as hormonal measures. Barely any women 35 and older use barrier methods.

Now, if you answered "no" to the question above, then you might want to consider permanent contraception, either for you or your partner. Female sterilization is the most common form of contraception overall, and the birth control method used most often by women 35 and older. There are two primary forms of female sterilization: the traditional tubal ligation, often called "getting your tubes tied," and fallopian tube occlusion, known as the Essure permanent contraception procedure, also called Essure Micro-inserts. The chart below compares the two.

Of course, you can always insist that it's time he took care of the birth control option and had a vasectomy.

No matter what you choose, just choose. Otherwise, you may find your 40s more, um, interesting than you'd planned!

References

Hamilton, BE, Martin JA, Ventura, SJ. Births: Preliminary data for 2005. National Vital Statistics Report. Centers for Disease Control; December 2006; 55(11).

Kailas NA, Sifakis S, Koumantakis E. Contraception during perimenopause. Eur J Contracept Reprod Health Care. 2005 Mar;10(1):19-25.

Jarrett ME, Lethbridge DJ. The contraceptive needs of midlife women. Nurse Pract. 1990 Dec;15(12):34-9.

Lindau ST, Leitsch SA, Lundberg KL, Jerome J. Older women's attitudes, behavior, and communication about sex and HIV: a community-based study. J Women's Health (Larchmt). 2006 Jul-Aug;15(6):747-53.

Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006 Jun;38(2):90-6.

Bhathena RK, Guillebaud J. Contraception for the older woman: an update. Climacteric. 2006 Aug;9(4):264-76. Review.

Food and Drug Administration. Birth Control Guide. Updated December 2003.

Essure Web site. Available at www.essure.com. Accessed April 8, 2007.

This content was developed with the support of an educational grant from Conceptus, Inc.

Create Date: 1/9/2008
Last Date Updated: 1/9/2008