Over 40

• Contraception after menopause:

  • If period stop under age of 50 - continue using contraception for 2 years since LMP
  • If period stops after age of 50 - continue using contraception for 1 year since LMP
  • Or stop contraception when reach 55 years of age
• Key points:

  • No contraception is contraindicated due to age alone
  • Recommended that patients aged 50 and over do not used combined hormonal contraceptives or progestogen-only injectable
  • Progestogen-only pill and implant, hormonal IUD, and the copper IUD can all be used safely until the age of 55
  • Natural loss of fertility is presumed at age 55
• Women over 40 have an age related increased background risk of:

  • Cardiovascular disease
  • Obesity
  • Breast cancer
  • Gynaecological cancer
• The progesterone-only injectable (DMPA) is not suitable for people aged 50 or over - reduces bone mineral density
• Combined hormonal contraception:

  • Can be used up to the age of 50 for the relief of perimenopausal symptoms and prevention of loss of bone mineral density
  • Not advised aged 50 and over - increased cardiovascular, VTE and malignancy risk
  • Increased risk of breast and cervical cancer (reduces risk of ovarian and endometrial cancer)
• Extended use:

  • Copper coil: until age of 55 if inserted at age 40 or over
  • LNG-IUS: until age of 55 if inserted at age 45 or over, provided it is not being used as the progestogen component of HRT for endometrial protection (5 years)