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  • Title: Contraception in women older than 40 years of age.
    Author: Thorneycroft IH.
    Journal: Obstet Gynecol Clin North Am; 1993 Jun; 20(2):273-8. PubMed ID: 8367131.
    Abstract:
    Women older than 40 years have high rates of unwanted pregnancy and abortion and traditionally have had limited choices of contraception agents. In today's market, oral contraceptives should be considered as should IUDs in properly screened candidates. Sterilization is effective for the couple who knows that they will have no more children. Mechanical methods are effective if used when intercourse tends to be a planned event and infrequent. With the variety of agents available in today's market, there is no reason why the unwanted pregnancy rate and abortion rate of the women older than 40 should not be reduced dramatically. Women over age 40 have high rates of unwanted pregnancy and abortion and limited choices of contraception. Oral contraceptives (OCs) with 20-35 mcg of estrogen can be recommended for these women as long as they do not smoke. Previously, some association was found between pill users aged over 35 years and an increased risk of myocardial infarction. Thus, OCs were not recommended for them. However, recent findings implicate smoking instead of age in the increased risk of myocardial infarction in OC users. OCs are useful in treating dysfunctional uterine bleeding of the perimenopause, in regulating menstrual cycles, and in preventing anemia. Other benefits include the reduction of endometrial and ovarian cancers, fibroids, endometriosis, benign breast diseases, ovarian cysts, ectopic pregnancy, and pelvic inflammatory disease. Monogamous and parous women with negative cervical cultures for gonorrhea and chlamydia can use IUDs. Sterilization is an option only after the completion of family size; tubal ligation, however, is associated with more morbidity and mortality than vasectomy. Thus, vasectomy should take precedence over tubal ligation. Depo-Provera injections every 3 months are safe, and they also help with dysfunctional bleeding and breakthrough bleeding via the production of amenorrhea. This drug is approved by the Food and Drug Administration and is popular worldwide. Long-term studies have not confirmed the increased risk of breast cancer with Depo-Provera use. Among implants, Norplant is almost as effective as tubal ligation, but it may cause dysfunctional bleeding in women over the age of 40. Mechanical methods also provide protection; however, they result in a pregnancy rate of 10-20% per year.
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