Midlife Contraception
By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville
Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim. This article originally appeared in the May 29, 2008 issue of Internal Medicine Alert. It was peer reviewed by Gerald Roberts, MD. Dr. Roberts reports no financial relationships relevant to this field of study.
Source: Kaunitz AM. N Engl J Med. 2008;358:12:1262-1270.
The mean age of attainment of menopause in American women—51 years—has not meaningfully changed over more than a century. During late reproductive life, pregnancy has more adverse consequences than in younger women. The therapeutic abortion rate of post-40 women is higher than any other age group except adolescents. Hence, midlife contraceptive decisions might be weighed differently than at other periods of reproductive life.
Kaunitz reviews multiple factors that impact contraceptive decisions after age 40. DVT risk after age 39 is more than 4-fold greater than in adolescent women, exaggerated further in obese women, in whom progestin-only oral contraceptives might logically be preferred. Older women who smoke should not be prescribed oral contraceptives, and Kaunitz recommends similar restrictions for midlife women with hypertension or diabetes.
Data on risk for breast cancer in association with oral contraceptives is largely reassuring, although data sets usually contain few women over age 45 to study. Oral contraceptives improve bone mineral density, and are associated with reduced risk for ovarian, endometrial, and colon cancer.
No method of discontinuation of contraception has proven ideal in all women. Kaunitz suggests continuing oral contraceptives, if well tolerated, into the early-mid 50s, after which pregnancy risk upon discontinuation is very low. The ideal candidate for midlife oral contraceptives is the lean, slender, nonsmoker.
The mean age of attainment of menopause in American women51 yearshas not meaningfully changed over more than a century. During late reproductive life, pregnancy has more adverse consequences than in younger women.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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