Contraception For Over 40s

Courtesy of My Generation. Article By Linda Wilson

The idea of buying condoms may have been exciting when you were in your teens; in your forties and fifties, it takes on a somewhat ludicrous slant. But if you’re into a new relationship, there’s no ignoring the fact that you still need protection.

Aucklander Lorna* was 44 when her periods stopped. They’d been irregular for a few months beforehand and that, coupled with a handful of hot flushes she’d experienced, convinced her that menopause had started.

But after several months she began to suspect that menopause wasn’t responsible for her lack of periods after all. “I was having all these familiar symptoms so I went out and bought a pregnancy test,” she recalls. “It was positive. I was absolutely bowled over. It just hadn’t occurred to me that I could get pregnant at that age.”

The news did not go down well with her partner, who had never had children by choice. “He was furious, to put it mildly. We’d been together for eight months and when I started having the irregular periods I had told him we could probably stop using condoms – which he hated – because I thought I was starting menopause and couldn’t get pregnant. Boy, was I wrong.”

Lorna’s partner could not cope with the idea of becoming a dad and the couple split up. With two teenage children from a previous relationship, she decided to keep the baby. “I adore my son and I can’t imagine life without him,” says Lorna, who is now in her early 50s. “But it has been really, really hard, bringing up a child on my own at my age. You can’t turn the clock back but there were times when I wished I had thought more about contraception.”

That’s a subject mum-of-three Suzanne* is having to consider for the first time in over a decade. Now 42, she divorced three years ago and has just started a new relationship.

“My ex-husband had a vasectomy after our youngest was born so I haven’t had to worry about contraception for about 10 years. My new partner and I have been using condoms but it’s not an ideal situation. The last time I used condoms I was a teenager and now using them seems slightly ridiculous when you’re both in your 40s and don’t have HIV or an STI. Plus I have concerns about how reliable they are.”

“The Pill seems the obvious choice to me because that’s what I used to use. However, my blood pressure has shot up in the last few years so I probably shouldn’t go on it. So it will have to be something else but I’m not sure what. This is all new territory for me and I’m a little bit embarrassed about going to talk to my GP about it, at my age.”

You should never feel shy about discussing contraception with your doctor, no matter what your age, says Dr Christine Roke, national medical advisor for Family Planning. “They’ve seen it all,” she says. “They know that people’s circumstances change so their contraceptive needs may change.”

Family Planning has recently produced a new resource specifically aimed at women over 40 who are starting a new sexual relationship and having to think about issues like contraception, often for the first time in many years. Called Upd@teMe, the booklet provides information on a variety of subjects from sexual etiquette to fertility.

While many forty-something women understand the need to protect themselves against sexually transmitted infections (STIs) when they start a new relationship, not everyone appreciates that they may also need contraception because they may still be able to get pregnant.

“Unfortunately not all women realise that they can still be fertile, even if they’re having irregular periods or other signs of the menopause,” says Dr Roke. “They may still be ovulating and therefore they can still get pregnant.

“We get women over 40 coming in to have their IUDs out and when we ask what type of contraception they are going to use next, often they will say they’re not planning on using anything. They don’t think they need contraception any more. It is a concern and you do hear from time to time about women in their 40s becoming pregnant unintentionally. For some of them it can be disastrous.”

Family Planning always recommends people of any age starting a new sexual relationship use condoms to protect against disease. Tests can show whether you or your partner have an infection and while results for some STIs (for example chlamydia) come back quickly, it can take around three months to learn the outcome of others, such as tests for syphilis or HIV. “During that time you should always use condoms,” says Dr Roke.

If you both have a clean bill of health and no longer want to use condoms there are quite a few contraceptive choices available. “It could be quite a long time since you’ve needed to think about contraception and there are options now that possibly weren’t there the last time you were deciding what to use,” says Dr Roke.

“The best thing to do is to go and see your doctor or come to us at Family Planning to discuss your particular situation. There are lots of things that need to be taken into consideration, such as your health. You need to find the contraception that is going to work best for you and your partner.”

* Names have been changed

FAQs

Q: I’m having menopausal symptoms such as irregular periods and hot flushes. Do I still need to use contraception, and if so, for how long?

Yes. You may still be able to conceive. If you are over 45, you should continue to use contraception until you’ve had no periods for a whole year. If you are under 45 you should use it until you’ve had no periods for two years.

Q: I’m on HRT. Do I need contraception? How long for?

Yes. HRT is not a method of contraception and if you have had periods in the last year (or two years if you’re under 45) you may still be able to get pregnant. Do not use the Pill if you’re taking HRT. Talk to your doctor about other forms of contraception such as condoms, IUD or diaphragm.

Because HRT causes monthly bleeds it is hard to know if your periods have stopped naturally. “That means it is difficult to tell when you are no longer fertile and can stop using contraception,” says Dr Roke. “Because the average age of menopause is 51 we usually advise women to keep using it until they are 52.”

Q: Is the Pill safe for women over 40?

The term ‘the Pill’ refers to the combined pill, which contains oestrogen and progestogen. It does carry a risk of blood clots, stroke and heart attacks and is generally not prescribed for 40-plus women, who may have an increased risk of these problems.

But you may be able to use the combined pill if you’re over 40 and are not overweight, don’t smoke, don’t have high blood pressure, diabetes or a family history of heart disease, says Dr Roke.

Q: Is the progestogen-only pill the best option for 40-plus women?

It depends on a variety of factors including your health and lifestyle, which you need to discuss with your doctor, but it is more commonly prescribed for women over 40 because it doesn’t have the same health risks as the combined pill.

One of its drawbacks is that it does have to be taken at the same time every day to be effective. It can also cause irregular bleeding and has a slightly higher failure rate than the combined pill.

Q: What other contraception choices do I have?

Apart from condoms, you could use an IUD (coil) or a diaphragm, although you do need good muscle tone to keep the diaphragm in place and that may be a problem for some women over 40.

Mirena is another option. This is a small plastic T-shaped device that is inserted in the womb and releases tiny doses of hormones. As well as providing long-term contraception, it is also used to control menstrual bleeding so can help if you have a problem with heavy periods.

Depo provera, the contraceptive injection, can also be used, but 40-plus women “don’t really require such good contraception”, says Dr Roke.

There are also progestogen implants but these are not subsidised and not available everywhere in the country, while natural fertility planning – checking for signs that you’re ovulating – can be tricky if your periods aren’t regular.

Sterilisation is another option but does involve fairly major surgery and some women may feel it is not worth it if they are only likely to be able to conceive for a few more years.

Q: Is there a test I can have that will show if I’m still fertile?

There is a blood test that measures levels of hormones called follicle stimulating hormones (FSH) and may indicate whether you could be approaching menopause but it is not conclusive, says Dr Roke. “Hormone levels tend to go up and down. You can have the test one day and it can suggest you are starting menopause and then the next day your hormone levels can completely change. You shouldn’t rely on it.”

A fertility prediction test is being developed which measures levels of a hormone called AMH, and may be able to show how many potential eggs there are left in your ovaries. However, this is not likely to be available for another couple of years.

* For a copy of the Upd@teMe brochure, which is free, go to www.familyplanning.org.nz.

Family Planning provides sexual health services for men and women of all ages. If you’re over 45, a visit to a clinic costs $22.50. Staff there can help with issues such as contraception, menopause support, checks and treatment of STIs (sexually transmitted infections), HIV testing, vasectomy and cervical smears.