This was an updated guideline from the FSRH on contraception in the over 40s. It came out in Nov 17, but as it is so useful, I thought it worth doing a summary. There were a few things that were new for me:
- If women over 50 are amenorrheic AND using a progesterone only method of contraception, then you can measure their FSH to gauge when to safely stop contraception. Only a 1 off measurement is now advised (they used to suggest 2).
- Depot injection. There are circumstances where you can continue to use the depot after age 50. See below.
- COC. There are circumstances where the COC can be continued for non-contraceptive benefits after age 50. See below.
- Women can safely stop contraception after age 55, even if they are still having menstrual bleeding.
What is the rate of pregnancy in the over 40s?
- 10 – 20% per year if 40 – 45
- 12% per year if 45 – 50
- Very rare in the over 50s
Why do over 40yr old women need to be considered separately?
The background risks of various diseases increase, hence the contraception that is appropriate changes.
- CVD risks. Start to rise in perimenopause. An early menopause is associated with an increased risk.
- VTE risk rises 10 fold between age 40 and 60 (from 1 in 10,000 to 1 in 1000).
- Breast, ovarian and endometrial cancer rates increase.
- Osteoporosis risk increases.
If women over 50 are amenorrheic AND using a progesterone only method of contraception, then you can measure their FSH to gauge when to safely stop contraception. Only a one-off measurement is now advised.