Oral contraception over the age of 40

Scientific data from the past decade have proved that the age of 35 years is not an obligatory border at which to stop taking oral contraceptives (OCs). Combined OC formulations (COCs) are safe and effective for healthy women up to the age of the menopause. The use of OCs in women who do not smoke does not result in an increased risk of cardiovascular disease. Since the risk of thromboembolism increases with age and the level of obesity in women of 40 and over, it is wise to prescribe the lowest available dose of ethinyl-estradiol in the COCs. Some authors prefer levonorgestrel to any third-generation progestogen in COCs, but the excess risk of venous thromboembolism associated with the use of third-generation products can be balanced by the reduced risk of myocardial infarction associated with the same products. When OCs are considered for perimenopausal women, it is important to take into account progestogen-only pills. In consequence of the reduced fecundity, these have a better contraceptive efficacy in this age group than in women aged below 35 years. Their only important possible adverse effect is an unpredictable bleeding pattern; further, they do not alleviate climacteric symptoms if these are present. In such cases, progestogen-only pills can be combined with cyclic hormone replacement therapy.