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Contraception Options for Women Over 40

Contraception Options for Women Over 40

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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 here: Do you want children? Or more children?

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If you answered yes, then you need reversible contraception. 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 and the IUD Mirena. All use the hormone progestogen to prevent pregnancy, and all can be used for months (Depo-Provera) or years (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, a minimally invasive nonsurgical procedure, sold under the brand Essure. The nonsurgical procedure involves inserting a small device into your fallopian tube, which then causes tissue to grow and form a permanent barrier that blocks sperm from reaching the egg. In 2016, the FDA ordered changes in the package labeling for Essure to include a boxed warning and a "patient checklist," both designed to ensure that women understand the risks and benefits of the device. The FDA is also requiring Bayer, the manufacturer of Essure, to conduct a clinical study to determine risks of Essure for particular women. The government agency has received about 10,000 complaints about Essure since its release in 2002.

The chart below compares tubal ligation and the nonsurgical permanent contraception.

 Tubal LigationNonsurgical Permanent Contraception (Essure, Adiana)
What is it?Surgical procedure. Surgeon makes a small incision through the abdomen, inserts a laparoscope to view the pelvic region and tubes, and either blocks the tubes with a ring or burns or clips them shut.Nonsurgical procedure. Hysteroscope is used to insert a small device through the vagina, cervix and uterus into the fallopian tube where, over three months, it forms a tissue barrier that prevents sperm from reaching the egg. After three months, a special x-ray is done to make sure your tubes are completely blocked.
Where is it performed?Hospital settingPhysician office
What type of anesthesia is required?General anesthesiaLocal anesthesia may be used. General anesthesia is not required, though it may be offered. Discuss your anesthesia options with your physician.
What are the risks?Pain, bleeding, infection and other postsurgical complications, as well as an ectopic, or tubal, pregnancyMild to moderate pain after insertion, very small risk of ectopic or tubal pregnancy
How long does it take to recover?Two weeks or moreWithin 24 hours

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!