e-Learning | Contraception in the over 40s

14th December 2018 by Louise Hudman

e-Learning | Contraception in the over 40s

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.

What contraception can women over 40 use?

Join

Join to view the rest of this content, as well as access all the benefits of joining NASGP.

Join

Login

Already a member? Login to view this content.

Login

Related content

"I feel strongly that sessional GPs need an organisation solely focussed on representing their interests."

Dr Tim Cantor

See the full list of features within our NASGP membership plans

Membership