Female contraception over 40

BACKGROUND The majority of women 40–49 years of age need an effective method of contraception because the decline in fertility with age is an insufficient protection against unwanted pregnancy. Although pregnancy is less likely after the age of 40 years, the clinical and social consequences of an un...

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Bibliographic Details
Published in:Human reproduction update 2009-11, Vol.15 (6), p.599-612
Main Authors: Baird, DT, Castelo-Branco, C, Collins, J, Evers, JLH, Glasier, A, La Vecchia, C, Leridon, H, Mishell, DR, Wellings, K, Arisi, E, Benagiano, G, Bitzer, J, Crosignani, PG, Diczfalusy, E, Lanzone, A, Skouby, SO, Stock, G, Volpe, A
Format: Article
Language:English
Subjects:
Adult
Age Factors
ageing
contraception
Contraception - methods
Contraceptive Agents, Female - administration & dosage
family planning
Female
Fertility - physiology
Humans
Infant, Newborn
Medicin och hälsovetenskap
Menopause - physiology
Middle Aged
Pregnancy
premenopause
sterilization
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Summary:BACKGROUND The majority of women 40–49 years of age need an effective method of contraception because the decline in fertility with age is an insufficient protection against unwanted pregnancy. Although pregnancy is less likely after the age of 40 years, the clinical and social consequences of an unexpected pregnancy are potentially detrimental. No contraceptive method is contraindicated by advanced reproductive age alone; thus there is a need to discuss the effectiveness, risks and non-contraceptive benefits of all family planning methods for women in this age group. METHODS MEDLINE searches were done by topic (epidemiology, age and reproduction, sexual function, delayed childbearing and specific contraceptive methods). The topic summaries were presented to the Workshop Group and omissions or disagreements were resolved by discussion. RESULTS The decline in fecundity in the fifth decade is insufficient for contraceptive purposes. Thus a family planning method is needed. Sterilization is by far the most common method in several countries. Copper intrauterine devices and hormone intrauterine systems have similar effectiveness, with fewer than 1% failures in the first year of typical use. Special considerations in this age group include the frequency of menstrual irregularity, sexual problems and the possibility of menopausal symptoms, all of which may respond to hormonal methods of contraception. CONCLUSIONS Women should be advised to continue with a contraceptive method until they have reached the menopause with its natural state of sterility.
ISSN:1355-4786
1460-2369
1460-2369
DOI:10.1093/humupd/dmp020