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  • Title: Approaches vary in managing the over-40 pill patient.
    Journal: Contracept Technol Update; 1988 Sep; 9(9):105-7. PubMed ID: 12342192.
    Abstract:
    This report on approaches in managing the over-40 pill patient details the results of a portion of the 1988 survey on oral contraceptives (OCs) done by the Contraceptive Technology Update. Varied opinions of 465 responding clinicians were marked by recommendations for cautious follow-up and by beliefs that for these women, combined OCs may provide noncontraceptive benefits that outweigh their function as birth control. The experts agreed that over-40 women were candidates if they met the following qualifications: Generally in good health; nonsmokers; no absolute contraindications for combined pill use; no clear risk for coronary disease, such as a family history of heart attack before age 50 or diabetes; and normotensive. All clinicians said cholesterol or lipid screening was an integral part of their required workup, all recommended reassessing cholesterol levels annually, and all agreed that blood pressure should be closely monitored. Some suggested obtaining annual fasting glucose or 2-hour postprandial blood sugar tests and regular mammograms. Clinicians were divided over how often this older patient should return to the clinic: some preferred every 6 months, some annually. Advocates for 6-month returns expressed the need to monitor blood pressure, breast and pelvic examinations, and certain cholesterol and blood sugar test results. Clinicians also disagreed about the pill of choice for these women. Recommendations included avoiding the monophasic levonorgestrel pill, using any low-dose pill, using "half-milligram pills," or using a triphasic pill. Regarding the age limits for pill users, clinicians said from age 45-50, which coincides with a decline in fertility and in the wish for a family. 1 clinician believed the age limits basically are arbitrary because new studies indicate the low-dose pills have no significant impact on clotting factors, lipoproteins, or carbohydrate metabolism.
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