Contraception for the over-40s
Our contraceptive needs may change as we get older - but we still have them... By Jane Murphy
Don’t be fooled into thinking you don’t have to worry about contraception once you reach a certain age.
Unwanted pregnancies and sexually transmitted infections are on the rise among the over-40s. What‘s more, our needs change as we get older - and the contraceptive choice you've been using may no longer be the best one for you. Here's all you need to know...
Why worry?
We all know our fertility starts to dip as we grow older - but that doesn't mean you can't still get pregnant. In fact, the highest rate of unwanted pregnancies is among the over-40s: around a third of pregnancies in this age group end in abortion. The chances are relatively slim, but you can still conceive during the perimenopause - the time leading up to menopause. Experts recommend you continue to use birth control until you've gone two years without a period if you‘re under 50, or one year if you‘re over 50.
Also, the rate of sexually transmitted infections (STIs) among the over-40s has more than doubled in under a decade, according to a 2008 survey. So if you're having sex with someone new, it's still wise to use a condom. Don't get caught out: keep a packet in your handbag.
Know your choices
A staggering 90% of women don't know the full range of contraceptive choices available to them, according to recent Department of Health research. And more than one in five women who'd consulted a healthcare professional opted for their current contraception without asking about alternative options. It may surprise you to learn there are now 15 methods available in the UK - so it's important to choose the one that's right for you.
Should I switch?
Once you pass 35, it's advisable to stop taking hormonal contraceptives containing oestrogen - such as the combined pill, contraceptive patch or ring - if you smoke, suffer from high blood pressure or are overweight. The reason? The oestrogen can put your blood vessels under increased pressure, placing you at greater risk of serious conditions such as heart disease or stroke.
However, if you're a healthy non-smoker, it should be safe to continue taking the combined pill until menopause. But be aware: due to its oestrogen content, it may control perimenopause symptoms, such as hot flushes and night sweats. It may be wiser to switch to another method if you‘re prescribed hormone replacement therapy (HRT): discuss the pros and cons with your GP.
The progestogen-only pill can be taken safely until menopause, but won't control any symptoms.
What other options are there?
Other popular contraception choices include condoms (which, obviously, offer protection against STIs, too) and the diaphragm or cap. The latter is useful if you want to opt for a non-hormonal method - but it does involve forward planning and can be a little messy, as it requires spermicide.
Longer term hormonal options include relative newcomer, the Mirena coil - a progestogen-only intrauterine system (IUS), which is fitted into the womb by a health professional and needs replacing every five years. Unlike traditional intrauterine devices (IUDs), it may make periods lighter and less painful.
What about sterilisation?
If you're in a long-term relationship and are certain you‘ll never want to get pregnant, sterilisation may be the best long-term solution. It can seem a little daunting - particularly as it involves an operation - but it's over 99% effective and fairly straightforward.
Male sterilisation - or vasectomy - has the best success rate. The lifetime failure rate is just one in 2,000 - compared to one in 200 in females (so that's quite a handy statistic to quote when you're weighing up the options with your partner)!
During a vasectomy, the vas deferens - the tubes that carry sperm from the testicles to the penis - are cut and tied or sealed with heat. It takes around 15 minutes and can be carried out under local anaesthetic. Female sterilisation takes place under general anaesthetic, and involves sealing, blocking or cutting and tying the fallopian tubes.
It's good to talk
It's vital you talk through all your contraception options with your GP or family planning practitioner - and let him or her know if you're experiencing problems with your current method or have any other sexual health problems, such as perimenopause symptoms. Remember, now's the time to be enjoying sex - not giving yourself unnecessary discomfort or anxiety.
Want further information? You can find out more about all the contraceptive methods available to you at www.talkchoice.co.uk. Or find your nearest family planning clinic at www.fpa.org.uk.
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