White-Wilson Medical Center

Your Needs Change As You Age...

What was the first kind of birth control you ever used? Was it "the pill"? The contraceptive sponge? Condoms only? Now, the really important question: Are you still using it today? Your choice of contraception should match your lifestyle and may need to change as your life changes.

For instance, if you're married and planning to become pregnant in the next couple of years, you probably don't want or need a long-term contraceptive like hormonal implants or an IUD. Or, if you are using Depo-Provera hormonal birth control, you may want to switch to a method with a more rapid return of fertility.

If you're single, and have several partners, you may need more than one option, like the birth control pill to prevent pregnancy and a condom to protect you from sexually transmitted infections. And if you're finished having children or know you wont be having any, you may find permanent birth control an attractive option.

The bottom line is that what was right for you when you first became sexually active is not necessarily what's right for you now, particularly if you're in your late 30s or 40s. We've put together some information that you may find useful in helping you decide what birth control is the right choice for you.

Contraception Facts to Know

  1. You can still get pregnant until you reach menopause.
  2. Many midlife women and their doctors mistakenly assume women can't get pregnant once they're perimenopausal.
  3. Nearly a third of pregnancies in women 35 to 39 are unplanned; nearly four out of 10 pregnancies in women 40 and older are unplanned.
  4. More than half of all unplanned pregnancies in women 40 and older end in abortion.
  5. Women's contraception choices change as they age.
  6. Before age 35, most women use oral contraception as their primary form of birth control.
  7. After age 35, most women use sterilization as their primary form of birth control.
  8. Healthy women over 35 who don't smoke or have cardiovascular disease can still use birth control pills until age 50.
  9. Combination oral contraceptives can help with perimenopausal symptoms such as irregular bleeding, hot flashes and night sweats and can reduce the risk of several types of cancer.
  10. There are several hormonal contraceptives available beyond the birth control pill, including a vaginal ring, patch, shot and implantable device.
  11. Women need to protect themselves from sexually transmitted infections (STIs) no matter their age or reproductive status.
  12. Midlife women who are exposed to STIs have a higher risk of contracting an STI if the vagina thins due to reduced estrogen production.
  13. There are two forms of female sterilization—known as permanent birth control: the Essure procedure, in which a miniature spring-like coil micro-insert is placed into the fallopian tubes, eventually blocking them, and tubal ligation, in which the fallopian tubes are blocked, burned or clipped shut.
  14. Unlike a tubal ligation, the Essure procedure can be performed in a doctor's office under a local anesthetic and doesn't involve any incisions.
  15. Female sterilization—known as permanent birth control—is the most common form of contraception overall; in women 40 and 44, the percentage of women opting for permanent birth control jumps to nearly 35 percent.

Contraception Tips for Your Lifestyle

  1. If you keep forgetting to take oral contraceptives, talk to your health care professional about a contraceptive option you don't have to think much about; this might include long-term contraception, such as NuvaRing, Implanon, DepoProvera or an IUD.
  2. If you've "been there, done that" and have decided you're finished with childbearing, or you've decided you don't want children, permanent contraception is a highly reliable birth control option. According to the U.S. Food and Drug Administration, all forms of sterilization, including the Essure procedure, have a failure rate of less than 1 percent (one pregnancy per 100 women).
  3. Today's birth control pills come with very low doses of estrogen, as well as a "mini-pill" option that contains no estrogen, only progesterone.
  4. There's a birth control option for nearly every lifestyle—whether reversible (oral contraceptives, barrier methods), long-term (injections, implants, IUDs), or permanent (Essure procedure, tubal ligation, vasectomy). Some options are vastly different, safer or more effective than the products of years past, while newer products may be unfamiliar to you. Be sure to discuss your preferences with your health care professional to find an option that fits your needs at your life stage.
  5. If you have medical or religious concerns about artificial birth control methods, talk to your health care professional about fertility awareness methods, sometimes called natural family planning. When used properly, these methods can prevent pregnancy up to 80 percent of the time.
  6. More than half of 17-year-olds have had intercourse. A sexually active teenager who doesn't use contraception has a 90 percent chance of becoming pregnant within one year. Studies show that teens who talk to their parents about sex, pregnancy, birth control and sexually transmitted infections are less likely to become sexually active at an early age and more likely to use protection when they do have sex.

Birth Control Pills

Many women start out using "the pill" as their primary form of birth control when they become sexually active. Cheap, easy to use and with few side effects, combination oral contraceptives (which contain estrogen and progestin) work to prevent pregnancy in several ways. They suppress ovulation, thin the lining of the uterus to prevent implantation and change the consistency of the cervical mucus, making it more difficult for sperm to reach an egg. Birth control pills are 91 to 99 percent effective if you take them correctly.

For years doctors warned that women over 35 shouldn't use the pill. But today we know that healthy women who don't smoke and have no history of cardiovascular disease can safely use the pill until age 50. This is particularly good news for women who use oral contraception as a way to manage the heavy or irregular menstrual bleeding that often occurs in midlife.

Combination oral contraceptives have other non-contraception benefits for women. Long-term use can increase bone mineral density and reduce the risk of hip fracture after menopause, while perimenopausal women may find it helps prevent hot flashes.

In fact, the World Health Organization notes that the benefits of combination oral contraceptives for healthy, nonsmoking women 40 and older outweigh any risks. Those risks include a slightly increased risk of breast and cervical cancer, high blood pressure and stroke, all of which disappear once a woman stops taking the pill.

One caveat: Oral contraceptives may mask menopause. That's why many health care providers recommend that women stop using them at age 50 so they can identify when menopause occurs. Another reason to stop at 50 is that a woman's risk of blood clots and stroke increase as she ages. Many doctors prefer switching women to an alternative birth control method at this point.

Other Estrogen-Based Options

In addition to oral contraceptives, women have other estrogen-based contraceptive choices, including:

NuvaRing: Inserted into the vagina like a tampon, this vaginal contraceptive ring releases a steady amount of estrogen and progestin throughout the month. It is worn for three weeks, then removed for a week, during which you have a period. Then you insert a new ring. Side effects include hormone effects similar to those from the pill and a mild increase of vaginal discharge. Like oral contraceptives, NuvaRing may increase the risk of blood clots and stroke, primarily in women who smoke. This method is 91 to 99 percent effective when used correctly.

Ortho Evra: This skin patch has hormones embedded in its adhesive layer. You apply it to your lower abdomen, buttocks or upper body (but not your breasts), where it slowly releases an estrogen and progestin for a week. It must be replaced every week. After three weeks (and three patches) you have one patch-free week, during which you get your period. The patch delivers a higher overall amount of estrogen than most birth control pills, and it's unclear whether this increases the risk of blood clots. This method also is 91 to 99 percent effective when used correctly.

Non-Estrogen Hormonal Birth Control

If you need or want to avoid estrogen-containing oral contraception, talk to your health care provider about a progestin-only pill, often called the "mini-pill." It can be used in women who smoke or who have estrogen-related side effects with combination oral contraceptives. These pills change the consistency of the mucus in your cervix, making it thicker so it's more difficult for sperm to reach the egg.

Other non-estrogen options include:

Depo-Provera (DMPA), or the low-dose form, Depo-Subq-Provera. This injection protects you against unwanted pregnancy for up to three months. It carries a slight risk of reduced bone mineral density (which disappears when you stop using it), so it isn't recommended for women with a high risk of osteoporosis. It can also cause unwanted spotting and irregular bleeding, but 80 percent of women experience no bleeding after two years of use. It is 91 to 99 percent effective.

Implanon. Implanon is a matchstick-sized rod that contains a progestin called etonogestrel. It is implanted in your upper arm and provides protection for up to three years. It is not recommended for women with a history of breast cancer. Common side effects include abnormal bleeding, headache and depression. Implanon is 99 percent effective when used consistently and correctly.

Mirena. This IUD continuously releases progestin called levonorgestrel for five years or longer. This type of IUD may be recommended to treat heavy menstrual bleeding. One advantage for perimenopausal women is that it significantly reduces bleeding from your period or stops bleeding altogether. The major side effect is some irregular bleeding. It's more than 99 percent effective when used as directed.

Emergency Contraception

This contraception is used after unprotected intercourse and should not be considered a routine form of contraception. There are two forms of emergency contraception:

Plan B: These pills contain the progestin levonorgestrel, found in many progestin-only birth control pills. You take the first dose as soon as possible after unprotected intercourse, preferably within 72 hours after, and a second dose within 12 hours. Plan B is available without a prescription, but you should call your pharmacy first or click here to find a pharmacy near you that carries it.

IUD: A health care provider can insert an IUD up to 120 hours (five days) after unprotected sex. This should prevent a fertilized egg from implanting in 98 percent of women who have been pregnant in the past and 92 percent of women who have never been pregnant.

Non-Hormonal Options

If you want to avoid hormonal birth control but still want a reversible form of contraception, you have several options:

Copper intrauterine devices: The copper IUD works by killing sperm and preventing fertilization. Depending on the device used, it is effective for five or more years. The ParaGard IUD is effective for up to 10 years. You shouldn't choose a copper IUD, however, if you already have very heavy or painful periods, common in midlife women. This type of IUD is more than 99 percent effective at preventing pregnancy.

Barrier methods: These include spermicides, the Today Sponge, diaphragms, Femcap, Lea Contraceptive, the cervical cap and condoms. They are not as effective as other methods. Barrier contraception methods typically prevent pregnancy 70 to 85 percent of the time, compared to more than 99 percent of the time with sterilization, implants and IUDs, and between 91 and 99 percent of the time with the birth control pill, patch, ring or injection, though using a spermacide can increase the effectiveness of barrier contraception. A major advantage of condoms, of course, is that when used properly they are the only form of birth control that also protects against most sexually transmitted infections, including HIV.

Barrier methods tend to be more popular with younger women—they are often used by couples when spacing pregnancies; just 8 percent of women 40 and older use a condom, and hardly any women 35 and older use any other barrier method.

Permanent Contraception Methods

Female sterilization—known as permanent birth control—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: a nonsurgical implant system, called "Essure," and the traditional tubal ligation, often called "getting your tubes tied."

The Essure Procedure: The Essure procedure can be performed in your doctor's office with local anesthesia. Your doctor uses a special instrument called a hysteroscope to place specially designed spring-like coils called micro-inserts through your vagina and cervix into the opening of your fallopian tube in your uterus. There is no incision. Within three months, the micro-inserts cause your body to form a tissue barrier that prevents sperm from reaching the egg. During this three-month period, you need to use another form of birth control. After three months, the doctor performs a special x-ray to make sure your tubes are completely blocked. In clinical studies, most women reported little to no pain, and were able to return to their normal activities in a day or two. Essure may reduce the risk of tubal (ectopic) pregnancy.

Tubal Ligation: An estimated 700,000 tubal ligations are performed in the U.S. each year, compared to 500,000 vasectomies, despite the greater risk of complications with tubal ligation. The phrase "getting your tubes tied" is a misnomer, however, since the fallopian tubes are not actually tied. Instead, they are blocked with a ring or burned or clipped shut. This procedure is typically performed under general anesthesia in a hospital. The surgeon makes a small incision through the abdomen and inserts a special instrument called a laparoscope to view the pelvic region and tubes and to perform the procedure. Recovery typically takes four to six days. Risks include pain, bleeding, infection and other postsurgical complications, as well as an ectopic, or tubal, pregnancy.

Male sterilization is called a vasectomy. This procedure is performed in the doctor's office. The scrotum is numbed with an anesthetic, so the doctor can make a small incision to access the vas deferens, the tubes through which sperm travels from the testicle to the penis. The doctor then seals, ties or cuts the vas deferens. Following a vasectomy, a man continues to ejaculate, but the fluid does not contain sperm.

All forms of permanent contraception carry a failure rate of less than one percent.

This content was produced for HealthyWomen.org with the support of an educational grant from Conceptus, Inc.

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