Birth control over 35

Each decade of your life brings new milestones. In your 20s and 30s, you may have been focusing on a career, a family, and financial stability. As you enter your 40s and 50s, the grind slows down and hopefully, you feel good about the life you’ve built.

While you’re out there accomplishing your goals, don’t forget one very important consideration: contraception. Even though fertility declines as you age, you can still get pregnant if you’re still getting your period — even if it’s not every month.

If having children is not in your plan but you’re still menstruating, then don’t part ways with your birth control just yet. Some women over 35 choose a permanent form of birth control called tubal ligation. Often called getting your “tubes tied,” this is a surgical procedure that involves completely blocking the fallopian tubes by inserting a ring, burning them, or clipping them.

However, if you’re still considering kids or you don’t want surgery, oral contraceptives — or birth control pills — are less permanent, don’t require surgery, and may come with some other benefits.

    5 Fast Facts About How Birth Control Pills Can Benefit Women In Their 40s and 50s

  1. They prevent pregnancy — and pregnant women over 40 have a much higher chance of complications.
  2. They can regulate heavy periods.
  3. They can reduce the risk of iron deficiency caused by heavy periods.
  4. They can lower the risk of endometrial cancer.
  5. They can reduce the risk of bone fracture from osteoporosis, which affects half of all adults over age 50.

Your reproductive health is complex — so are the choices you need to make when it comes to contraception. In your 20s and 30s, you may have taken birth control pills for primarily one reason: to avoid pregnancy.

As you get older, however, there may be some extra benefits. Though these benefits may apply to other forms of birth control, such as the ring, the implant, or the shot, studies need to be done to be sure about their benefit.

Here are four benefits of taking birth control pills when you’re over 40.

1. Birth Control Pills Work — If You Take Them Correctly

In your 40s, your chances of a successful pregnancy drop because the quantity and quality of your eggs decrease. Even though it may be more difficult for those eggs to be fertilized, it can still happen. In fact, 80 percent of women between 40 and 43 years old can still get pregnant.

While it’s completely possible to have a baby without complications over 40, your chances of miscarriage, delivery complications and birth defects, such as Down’s Syndrome, are higher.

Birth control pills are a more effective form of contraception than many others — such as diaphragms, condoms, withdrawal, and spermicides. They also don’t require surgery, unlike tubal ligation.

Your chance of getting pregnant doesn’t go away completely until you go without your period for at least 12 months. If you plan on being sexually active and you’re still getting your period, birth control pills may be the way to easily and effectively prevent an unplanned pregnancy in your 40s.

2. They Can Regulate Your Period

In your 20s, you may have been used to a regular period that came once a month and didn’t disrupt your life too much. However, when your hormones levels drop very quickly during perimenopause, your body may react with heavier, more frequent, or more painful periods.

These sudden and major fluctuations can be tough. Oral contraceptives may regulate your period as your body gets a handle on your changing hormones.

For some women, menstrual bleeding can even be heavy enough that it leads to anemia — when your blood doesn’t carry enough oxygen to the rest of your body. This can make you feel tired, cold, dizzy, and irritable — on top of any other menopausal symptoms.

Taking birth control pills may be a way to lighten your period, reducing your risk of anemic symptoms that take an extra toll on your body.

3. Birth Control Pills Can Keep Your Bones Strong

Remember all of those times you were told to drink your milk as a child? That’s because from childhood to young adulthood, your bones are growing and getting stronger. When you’re in your early 20s, they’re at their strongest.

Over time, your bones become less dense and more fragile. As you enter your 30s, they become more porous, more brittle, and more likely to break — even if you did drink the milk.

Osteoporosis is a health condition that weakens your bones — and it’s very common as you enter your 40s and 50s. Half of all women will break a bone because of osteoporosis at some point in their lives. And because there aren’t usually any symptoms before your first broken bone from osteoporosis, it can be difficult to tell if you’re at risk.

While there are other simple ways to maintain bone health, such as getting enough calcium and avoiding smoking, oral contraceptives have been shown to maintain your bone health — keeping them stronger and less likely to break.

4. They Can Reduce Your Risk of Some Cancers

As a woman, your reproductive system is essential to your body: It provides you with important hormones, and it allows you to have children. However, these organs also come with risks, such as cancer in the ovaries and uterus.

Cancer in the lining of your uterus — called endometrial cancer — is the most common cancer in the reproductive system, and over 60,000 new cases are diagnosed each year.

Ovarian cancer, on the other hand, is less common — roughly 20,000 cases are diagnosed each year. However, over half of the women diagnosed with ovarian cancer lose their lives to it, and it causes more deaths than any other cancer in your reproductive system.

Taking oral contraceptives may reduce your risk of both of these cancers by at least 30 percent. This protective effect also doesn’t go away when you decide the pill is no longer for you, either — it can last for years after you stop using birth control pills.

What Risks Are Involved with Taking Birth Control over 40?

When you take an oral contraceptive, you’re adding extra hormones to your body. While that can be beneficial in many ways, it does come with some risks — especially as you enter your 40s.

Some medical conditions are more common as you get older, such as cardiovascular disease and high blood pressure. Taking birth control pills may increase your risk of cardiovascular complications, such as:

  • Blood clots
  • Heart attack
  • Stroke

If you have a history of heart disease, high blood pressure, or blood clots and you’re over 35, birth control pills may not be the best option for you. Also, women over 35 who smoke are at particularly high risk for cardiovascular diseases and should, first of all, stop smoking. Also, talk to your doctor about whether birth control makes sense for you.

The Birth Control Pill: Is It Right for You?

As a woman, getting older comes with changes that may surprise you, delight you, or frustrate you. Just like many other stages of your life, both your body and mind take time to adjust.

While oral contraceptives can be an easy and effective way to combat some of the more overwhelming side effects of aging, it may not be the best option for all women. And remember, it may not address all of your concerns, either.

Talk to your health care provider about the benefits and risks of taking the birth control pill as you get older. It may just help you focus on the joys of getting older.

Still have questions about taking birth control in your 40s and 50s? Call (785) 270-4440 to set up an appointment with a Stormont Vail primary care provider to discuss the benefits of oral contraceptives.

Jan. 6, 2003 — It’s OK to take the pill — even if you’re over 35.

It’s news to many women. But it’s not a new finding. The problem is that older versions of birth-control pills had very high doses of estrogen that were associated with increased risk of blood clots, especially in women over 35. The lower-dose pills now in use have no such problems, according to recent studies.

Still, the earlier scare has made many women prefer to be safe than sorry. Only 4% of women older than 35 use birth-control pills. Now a prominent article in the Jan. 7 issue of Annals of Internal Medicine says it’s time for women and their doctors to discuss these misperceptions.

“Oral contraceptives can be safely prescribed to many women older than 35 years of age until menopause,” write Christine Seibert, MD, of the University of Wisconsin Medical School, and colleagues.

As a birth-control method, the pill is highly effective. Failure rates in the first year of use range from 0.1% to 5%, depending on how faithfully a woman takes the pills.

Perhaps most surprising to many women is that the pill has benefits that go beyond birth control. These include:

  • Lower risk of ovarian cancer.
  • Lower risk of endometrial cancer.
  • Possibly lower risk of colon cancer.
  • Relief of many symptoms of menopause.
  • Acne improvement.
  • Possible improvement in excess facial/body hair.
  • Possible improvement of bone density (therefore, possibly decreasing risk of bone thinning osteoporosis).

As with any medicine, there are some women who definitely should NOT take birth control pills. Women considering taking oral contraceptives should discuss the issue with their doctors.

Birth Control Choices for Women 35 and Older

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Wyatt Myers Was this helpful? (53)

It used to be that most women were finished having children by age 35. Not anymore. Many women are delaying having children longer than they used to. For this reason, many women in this age group are exploring their birth control options for family planning. If you’re a woman 35 or older, what’s the right birth control method for you?

Risk Factors for Birth Control After 35

The main concern for women 35 and older has had to do with birth control pills. For decades, studies showed that birth control pills were risky for women of that age. The belief was that these pills raise the risk of cancer, stroke, and heart disease as women grow older. There is evidence that the risks of breast, cervical, and liver cancer appear to be slightly increased in women using oral contraceptives.

However, given the current research, common birth control pills are thought to be safe in women into their 50s. There are a few exceptions. You might not want to choose birth control pills if you smoke or have a history of certain cancers or blood clots. Otherwise, modern birth control pills seem quite safe. Women older than 35 can choose this birth control method with few worries about health risks.

Any concerns about other birth control options have nothing to do with age. The reality today, then, is that birth control choices for women older than 35 are about the same as for those younger than 35. One possible difference is that older women may be more certain about being finished with having children. That means they might be more likely to choose a permanent type of birth control rather than a temporary method.

What Are Temporary Birth Control Choices?

You can choose from several temporary methods of birth control. These include:

  • Barriers: These include sponges, diaphragms, and male or female condoms.

  • Birth control pills: The pill, as it’s called, is now considered safe for most women older than 35. Those who shouldn’t use this option are women who smoke, have a history of blood clots, or have a family history of heart disease or cancer.

  • Rings or patches: You use these hormone-based products for three weeks at a time. You remove the device the week of your period and replace it with a new one. You can put the patch on several areas of your body. The ring is inserted in the vagina.

  • Injections: For this type of birth control, you get a shot of the female hormone progestin every three months. However, you should not use this method for more than two years in a row. That’s because it can decrease bone density over time. This makes it not the best choice for older women.

  • Implantable devices: You have a procedure to put this device (that can contain hormones) into your body. Implantable devices can prevent pregnancy for several years.

What About More Permanent Methods?

After age 35, most women decide at some point that they’re finished having children. You then could choose a permanent method of birth control. These include:

  • Surgical sterilization (tubal ligation): This procedure involves cutting and sealing the fallopian tubes. This prevents eggs from traveling to the uterus.

  • Nonsurgical option: A spring-like device that blocks the fallopian tubes is implanted in your body. Scar tissue forms around the spring to block the passage of eggs.

  • Vasectomy: This would be a procedure for your male partner. It prevents pregnancy by blocking sperm from entering his ejaculate.

Women’s Wellness: Do I still need birth control?

Birth control is often something women, perhaps in their forties or early fifties, stop worrying about a little too soon. Mayo Clinic gynecologist Dr. Petra Casey says, “We find that in most of the research, by the time a woman reaches the age of 55, she is 95 percent likely to have gone through menopause. Menopause is defined as one year of no periods. If you reach 11 ½ months of no periods, then have a period, the clock starts all over again and you’re still not in menopause.”

The article below is written for the Office of Women’s Health by Dr. Casey.

Do I still need birth control?

Wondering when you’re menopausal and can safely stop birth control? What birth control is best for women over age 35 or 40? Can you still get pregnant in your 40s and 50s? These are common questions women ask of their gynecologists, women’s health physicians and other health care providers.

Overall, almost half of all pregnancies and 75 percent of pregnancies in women over 40 years of age are unplanned. 1,2 Also, some pregnancy complications and risk of miscarriage go up with age. So, if you don’t want to become pregnant, using effective birth control until you are truly menopausal is very important.

Watch: Dr. Casey discusses birth control for women approaching menopause.

Journalists: Broadcast-quality sound bites with Dr. Casey are in the downloads.

Depending on your medical history, your health care provider will talk with you about the best options for you. If you are at a healthy weight, don’t smoke, don’t have high blood pressure or history of blood clots, you can probably continue the oral contraceptive pill, patch or ring well into your 50s. 3

Other great options which don’t contain the hormone estrogen include IUDs, implants, shots and minipills. Some IUDs contain the hormone levonorgestrel, a kind of progestin, which helps decrease or even eliminate heavy menstrual bleeding, a common problem for women in their 40s. These types of IUDs last 3 to 5 years. Another kind of IUD is made of copper, does not contain hormones and can last up to 10 years. Both types of IUD and the contraceptive implant, a small flexible rod which is inserted under the skin of your arm for 3 years of birth control, are collectively called long-acting reversible contraception (LARC). They are more effective than pills, patch or ring, don’t contain the hormone estrogen (so women who cannot use estrogen can use these), and can protect you against pregnancy for several years. 4

Just in case you had unprotected sex and you don’t wish to become pregnant, there are also several kinds of emergency contraception, previously known as the morning after pill. There are pills called Plan B One-Step which you can get at your local pharmacy without a prescription. They contain the hormone levonorgestrel and delay ovulation or release of an egg. They do not interfere with an established pregnancy or cause a miscarriage. Plan B should be taken as soon as possible after unprotected sex but must be taken within 72 hours. Another option which is more effective, especially if you are heavier, is Ella. Ella is effective in decreasing the risk of pregnancy up to 5 days after unprotected sex but requires a prescription. A copper IUD inserted within 5 days of unprotected sex is the most effective option for emergency contraception but requires an appointment with a health care provider. The advantage of the IUD is that you can keep it for birth control for up to 10 years (and about 80% of women do). 5

Once you have missed your period for a year, you are considered menopausal and may safely stop birth control. About 90-95% of women will be menopausal by age 55 and may stop birth control then. Sometimes lab tests are also performed to confirm menopause, but most women don’t need them. Even before the final period, many women experience menopausal symptoms such as hot flashes and trouble sleeping. You can start on menopausal hormone therapy using an estrogen patch to help manage symptoms and use one of the progestin-only birth control options for contraception and to protect the uterine lining from growing too much with the estrogen. The progestin-containing IUD, implant, shot or minipill all work well for this. If you have had a hysterectomy, you can take estrogen alone. 6 If you would like to avoid hormones as you transition into menopause, you can use the copper IUD, barrier methods like condoms, cervical cap, diaphragm or sponge, or have a minor surgical procedure to tie or block your fallopian tubes. Your health care provider can help guide you in choosing the best birth control option for you during the menopausal transition.

  1. Finer LB,. Zolna, MR Declines in Unintended Pregnancy in the United States, 2008–2011.N Engl J Med 2016; 374:843-852March 3, 2016DOI
  1. Shifren, JL, Gass, ML, for the NAMS Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society Recommendations for Clinical Care of Midlife Women Menopause: The Journal of The North American Menopause Society Vol. 21, No. 10
  1. ACOGCommittee Opinion no. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy.American College of Obstetricians and Gynecologists Committee on Gynecologic Practice.; Long-Acting Reversible Contraception Working Group..Obstet Gynecol. 2009 Dec;114(6):1434-8

Over 35? The Best Birth Control Options for You

By the time you reach your late thirties or forties, you probably feel like a pro at this whole birth control thing (you’ve been using it for decades, right?).

Actually, it might be time to take another look at your contraception-of-choice. Experts say age 35 is a great time to reevaluate your birth control options and think about what’s best for you at this stage of life.

One very important consideration: If you smoke and take birth control pills, your health risks skyrocket after 35. And there are other things to consider too — from your family-planning goals to your marital status.

Here’s how to decide what’s best for you.

The Right Birth Control for Your Health Status

For most women 35 and older, hormone-based birth control (like the Pill) is safe — but there are risks if you smoke or have a history of certain health conditions.

If you smoke: Don’t use contraception that contains estrogen, says Alice Chuang, MD, assistant professor in the department of obstetrics and gynecology at the University of North Carolina School of Medicine in Chapel Hill.

Smoking interacts with estrogen in the arteries in a way that increases risk for heart attack and stroke, Dr. Chuang says. Research has shown that the risk becomes statistically significant after age 35 — probably because women are at higher risk for a number of health conditions as they age.

If you have a history of blood clots: Avoid contraception that contains estrogen, Chuang says. You should also avoid this type of birth control if you have had a cancer that grows because of estrogen.

If you have these other health conditions: Talk to your doctor about possible risks if you have severe diabetes, hypertension, migraine headaches that cause an aura, or liver or bladder disease, Chuang says.

And remember that more than combination birth control pills contain estrogen — it’s also in the vaginal ring and the patch. However, there are plenty of options that include only progestin, such as pills, injections, and an intrauterine device (IUD).

The Right Birth Control if You’re Planning a Family

Doctors tend to advise women 35 and older who want to have kids to get pregnant sooner rather than later — that’s because fertility decreases after 35, says D. Michael Armstrong, MD, clinical associate professor in the department of obstetrics and gynecology in the division of women’s primary healthcare at the University of North Carolina School of Medicine in Chapel Hill.

If you still want to get pregnant someday: Choose a birth control option that allows you to return to normal monthly ovulation right away after stopping the contraception, Dr. Armstrong says. Choices include the pill, the ring, and the patch.

It’s better not to go with an implant or a shot because it can take a while to ovulate after stopping, he says.

If you’re done having babies: In addition to the pill, ring, or patch, your options also include an IUD, an implant, shots, or even male or female sterilization.

The Right Birth Control for Your Budget

If you have insurance, the cost of birth control usually isn’t going to be an issue because there are so many options, Chuang says. If one type of contraception isn’t covered by your insurance, it’s as simple as finding another that is. And in 2012, health plans will be required to provide contraceptive services (including birth control pills) without a co-pay.

Some types of birth control, such as the IUD and sterilization, are more expensive upfront, but they cost nothing additional for years afterward.

If you don’t have insurance and money is tight, there are programs that will help you pay for contraception.

The Right Birth Control for Your Relationship

When you’re married or in a committed relationship, sexually transmitted diseases, or STDs, aren’t usually a concern. But women who are single and starting new sexual relationships need to protect themselves from STDs, Chuang says. If you’re single, the most effective way to protect yourself is to use condoms — with or without another form of birth control.

There’s a lot to think about when you’re making a decision about birth control, but the good news is that you have plenty of options. Think about your health, your family planning goals, and your financial and marital status as you decide what’s best for you.

Explore Methods

It’s always been more than just birth control. It helped spark the sexual revolution. It’s a feminist icon that’s been letting women live life on their own terms for 50+ years. And if you’re thinking about using it, here’s everything you need to know to find the right one.

While an IUD or implant may make more sense if you don’t want to get pregnant for at least a year or two, the pill is a bit more flexible. Most types of birth control pills should be completely covered by health insurance, unless you use a brand name that has a generic equivalent.

Different kinds of pills and how they work

The pill is made of synthetic hormones like those that occur naturally in your body. There are basically two different kinds of pills, the combination pill and the mini-pill.

Combination pills

Combination pills contain two types of hormones, estrogen and progestin. They prevent pregnancy in three ways: by suppressing ovulation (meaning your eggs stay put in your ovaries); by thickening cervical mucus (making it harder for sperm to move); and by thinning the lining of the uterus (making it harder for an egg to attach there). This type of pill is more widely used than the mini-pill. (BTW, the patch and ring also contain both estrogen and progestin and have the same efficacy and safety profiles as combo pills.)

Combination pills vary by type of progestin and amount of estrogen. (They either have 35 or 20 micrograms of estrogen.) Different pills also have different amounts of hormone over the course of the month.

  • “Monophasic” pills have an even amount of hormone throughout the month.

  • Other pills have varied hormone doses through the month, most commonly three doses in “triphasic” pills. Theres no evidence that triphasic pills have any benefit when compared to monophasic pills among large groups of women.

A note on brand names: In terms of efficacy or “good” side effects like better skin and periods, no brand of pill has been shown to be more effective than any other, which means there’s typically no medical reason to use an expensive name-brand pill. So if you’re stuck with a large bill or copay for a brand name that has a generic, ask your health care provider about switching to the generic. Even without insurance, many pharmacies have pills available for less than $10 per pack.

Combination pill names: Alesse, Apri, Aranelle, Aviane, Enpresse, Estrostep, Lessina, Levlen, Levlite, Levora, Loestrin, Mircette, Natazia, Nordette, Lo/Orval, Ortho-Novum, Ortho Tri-Cyclen, Yasmin and Yaz. (Not quite as clever as nail polish names, but they get the birth control job done.) Lybrel, Seasonique and Seasonale (generic names: Jolessa or Qualsense) are combo pills that can minimize periods to just a few times a year or less.

Benefits: Combination pills are linked to less crampy, lighter, shorter periods. (That can also mean less chance of anemia.) These pills may also clear up acne. The combo pill reduces the risk of ovarian and endometrial cancer.

Combination pills might not be right for you if: you are sensitive to estrogen’s side effects like nausea or breast tenderness. To help with estrogen’s side effects, you can try lower-dose combination pills, which contain less estrogen, but they might cause more between-period bleeding (a.k.a. spotting).

You should not take the combination pill if: you have certain health conditions like high blood pressure or migraines with aura. The combination pill is also contraindicated (meaning risky to your health) if you smoke and are over 35. It’s important to know that if you have a contraindication, the amount of estrogen doesn’t matter—it’s not safe to use any method that contains estrogen at all. The bottom line is it’s always important to talk to a health care provider about your medical history before starting a new birth control method. One more thing: If you’ve given birth recently, you should avoid combination pills and other methods with estrogen.

Heads up: The combo pill might be advertised as highly effective, but in real life about one in 10 women become pregnant while using it. This can be for a range of reasons, from missing pills to changes in a woman’s metabolism. It can also be less effective against pregnancy if you use it while taking any of the following: the herbal supplement St. John’s Wort; HIV and seizure medicines; topamax/topiramate, which can be used to treat seizures or migraines; or the antibiotic rifampin, which is used to treat tuberculosis. (Other antibiotics are fine to take with the pill.) These medicines limit your body’s ability to adequately absorb the pill’s pregnancy-preventing hormones. If you take these meds, consider a birth control method that doesn’t contain estrogen, such as the mini-pill, an IUD, the shot, or the implant.

Inactive pills: There are typically four to seven inactive or placebo pills in each monthly pack. These are the pills that have no or a low-dose of hormones. You take these to maintain your daily habit of taking your pill at about the same time each day. (Speaking of taking your pill everyday, did you know that Bedsider has a free app that will send you clever birth control reminders? .)

Mini-pills

Mini-pills contain only progestin. They prevent pregnancy by thickening your cervical mucus and thinning the lining of the uterus. Some mini-pills suppress ovulation, but that’s not the main way they work. The mini-pill was developed for women who are sensitive to estrogen. It has the same failure rate as the combo pill—about one in 10.

Mini-pill names: Camila, Errin, Jolivette, and Micronor.

Benefits: The mini-pill is safe for people who are at risk of heart disease or strokes, or are heavy smokers. It’s also safe when you’re breastfeeding.

Inactive pills: Unlike the combo pill formulas, every mini-pill in your pack is active. Take one every single day, at about the same time each day. (If you ever have trouble remembering, Bedsider’s app can help.)

Popular pill-related questions

Can I use the pill to have my period less often, or to skip a month once in a while?
Yes. If you have heavy, painful periods, or conditions that make your menstrual cycle suck—like migraines, endometriosis, or epilepsy—then skipping periods could be awesome.

Most combination pills contain 21 active pills and seven placebos, or 24 active pills and four placebos. You usually get your period when you’re taking the placebo-pills. To skip that month’s period, don’t take the placebos—just go straight on to the first active pill in the next month’s pack. Read more about skipping periods with the pill (or the ring) and talk to your provider if you’re interested in this option. Note: This only works for combo pills, not mini-pills!

Newer combination pill formulations have been developed that give you four or fewer periods a year. Instead of a 28-day pill pack, they typically come in packets of 84.

What other birth control methods contain estrogen?
Like the combination pill, the patch and the ring both contain estrogen and progestin. Progestin-only methods include the mini-pill, the shot, the implant, the Mirena and Skyla IUDs, and levonorgestrel-based emergency contraceptive (EC) pills.

Isn’t estrogen for women going through menopause?
It can be. Our bodies’ estrogen surges during puberty and declines during menopause, which typically occurs anywhere between ages 40 and 55.

Some women use estrogen pills, patches, or creams to relieve the hot flashes, vaginal dryness, or other not-so-fun symptoms of menopause. Progestin is also used in some hormone-replacement therapies to protect the lining of the uterus from developing cancer. Estrogen also helps your body process calcium. Females who lack estrogen—because they are menopausal, or don’t have periods because of intense athleticism or eating disorders—can be at risk of osteoporosis.

Is there a connection between the pill and cancer?
Recent studies show no difference for pill takers or non-pill takers. Other studies indicate the combo pill reduces the risk of ovarian and endometrial cancer, and maybe colon cancer too.

Everything in life comes with possible risks and benefits, including pregnancy—which researchers say poses many more health risks than does the use of hormonal birth control. Because so much depends on your body, the safest route is always to discuss your family history and any other concerns with your health care provider.

And when it comes to birth control information, always keep in mind that some organizations and individuals exaggerate or twist the possible links between hormonal birth control and disease because they want to scare women away from having sex outside of marriage.

The truth is, medical researchers have found that the pill can decrease your risk of some cancers. Again, you’ll have to weigh the benefits and risks to find out if the pill is right for you.

What about the pill and migraines?
Some people who experience migraines say the pill makes them better, others say just the opposite, and some say the pill makes no difference at all. Wish we had a definitive answer here, but your mileage may vary.

People under 35 who have migraines without aura generally do fine on any type of hormone-based birth control. Those who have migraines with aura, and any migraine sufferer over age 35 (with or without aura) should generally not use estrogen-containing methods due to increased risk of stroke.

If the combination pill or some mini-pills keep my eggs from being released, does this mean that I’ll remain fertile longer than I would off the pill? Say I take the pill from age 18 to 40; will all those eggs still need to come out one by one in the form of continued periods after I stop taking the pill?
Nope. You eggs don’t “store up” in this fashion. They age and tend to dissolve and break down over the years. There’s no real difference between pill takers and people who never used hormonal birth control when it comes to how old you’ll be when menopause begins.

My friend loves her pill. Should I just go on that one too?
Maybe, but you still have to discuss it with your health care provider to find out for sure. Just because it works for your best friend doesn’t mean it’s the perfect pill for you, and vice versa. Every body is different, and you really have to try it to know if it’s right for you.

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Contraceptive methods and use by women aged 35 and over: A qualitative study of perspectives

Eighteen women were interviewed. One woman had never been sexually active, despite stating so on the screening questionnaire and thus was excluded from the analyses. Nine women reported at least one unintended pregnancy after age 35, eight did not. The respondent characteristics are listed in Table 1. Most women with at least one unintended pregnancy after age 35 were currently using male condoms, whereas many women who did not have an unintended pregnancy after age 35 were currently using combined oral contraceptive pills. Only two respondents (both who had had an unintended pregnancy after age 35) were currently using methods considered “very effective” by the World Health Organization (intrauterine contraception and contraceptive implant).

Table 1 Participant Characteristics

Factors influencing contraception use, especially between many women who had an unintended pregnancy after age 35 versus those who did not, were varied. The women without an unintended pregnancy after age 35 were more likely to (1) use contraceptive methods that helped treat a medical condition, (2) consider pregnancy as dangerous, or (3) express concerns about the responsibilities of motherhood.

Treatment of a Medical Condition

Respondents who reported using a contraceptive method to treat an existing medical condition, such as a gynecological disorder tended to report contraception adherence. I.T. is a 46-year-old woman without a prior history of unintended pregnancy after age 35. She is currently using the pill, which she described as helping her menopausal symptoms:

As I get older, I’ve learned that they’re also an advantage because they’re supposed to ease you into the menopausal stage relatively easily, so that you have less symptoms of menopause. It’s supposed to ease hot flashes and so forth, so that’s one of the reasons I’m staying on it.

I.T. reports she tried other birth control methods including male condoms and the diaphragm, but that she likes the pill the best because she learned from her doctor that it would ease her symptoms into menopause.

N.S., is a 48-year-old woman who had an unintended pregnancy at age 37 while using condoms inconsistently. She reports after her unintended pregnancy she received reassurance from her physician that the pill was safe and would help resolve her chronic menstrual disorder:

I have always had really horrible periods and was diagnosed with anovulation when I was in my… 20 s and so… for many years I was on the pill and then for many years I just had lots of break-through bleeding and lots of complications so I…went off and had D&C’s because of the anovulation. And so, I used other forms of birth control, like condoms and then in my late… 30’s after my unplanned pregnancy, I got put back on the pill and I’ve been on the pill ever since. And that was really to control heavy bleeding. … I mean that’s been a God-send…

Although N.S. had an unintended pregnancy after age 35 while using condoms, she reports successful use of the oral contraceptive pill for more than a decade because of her understanding and first hand experience that the pill is treating her chronic medical condition of anovulatory bleeding.

Dangers of Pregnancy

Respondents who perceived becoming pregnant as dangerous at their particular age, also expressed meticulous use with their contraception method. S.C. is a 40-year-old woman with two children and no history of prior unplanned pregnancy after age 35. She explains how she had had two previous difficult pregnancies and is currently struggling to find the right birth control method. S.C.’s mother was diagnosed with breast cancer after age 65, which prompted her to stop considering any contraceptive method containing estrogen. She chose to use the progesterone-only pill and struggles with the uncertainty of its lower efficacy rate. S.C.’s personal difficulties from her previous pregnancies motivate her to use contraception diligently. She explains that she missed a pill several months ago and was worried about possibly becoming pregnant when her period was late because “it’s too much of a risk.” She reflects about her close call with an unintended pregnancy:

I would have weighed everything against it, being older, difficult pregnancy, risks of something going wrong, disadvantages of problems on the family, in terms of it being hard on my husband, him having much more to do, it’s very difficult for him. And it would be hard for my other two children. I would have taken a break from parenting them because I was flat out on the sofa …. So, our family is complete… I pretty much never miss a pill…

In recognizing that pregnancy itself is difficult and that it could impose health problems, S.C. pays close attention to taking her progesterone-only pill.

F.H., a 41-year-old woman who had an unintended pregnancy just before she turned 35, states she uses condoms with every act of intercourse. She was diagnosed with a clotting disorder during her last pregnancy and had to take medication postpartum:

I don’t take any chances…. I know that it would be dangerous for me to have more now because of this clotting disorder, so I don’t really take any more chances. Not that I ever took too many anyway. I didn’t take any except once and I got pregnant.

F.H. was impacted by her unintended pregnancy, which technically occurred just before she turned 35. Nonetheless, from that pregnancy she learned that pregnancy is more dangerous as she gets older, particularly with presence of a medical condition. Her expressed fear of developing health problems with a pregnancy appears to motivate F.H. to use condoms consistently.

Concerns about the Responsibilities of Mothering

Respondents who expressed apprehensions about mothering tried to be conscientious about their contraception use. R.Z. is a 37-year-old, childless woman and no history of unintended pregnancy after age 35 who was recently married and desires children with her new husband. He, however, is satisfied with the two children he has from a previous marriage. Although ambivalent about pregnancy, R.Z.’s concerns about the responsibilities of motherhood and desire for leisure influence her contraception use:

I haven’t had any children. We’re in the process of trying to decide whether we want to have children now or not and I’m really, really on the fence. It’s a hard decision to make. Had we been facing this choice even five years ago, I absolutely would have started a family. But now I’m thinking that by the time I would actually get pregnant and have the child, I’m looking at being 40 and 40 and a toddler and I’m considering going to graduate school and there’s just so many pieces in the decision that weren’t as significant factors before. So now it’s really a lifestyle decision. I would love to have a child. I would love to parent…, but I’m thinking towards retirement….

R.Z. seems to have considered her responsibilities in being a mother very seriously. She appears ambivalent about having a child in the context of other things she would to have in her life, such as being a graduate student.

The women who tended to avoid unintended pregnancy after age 35 talked about their adherence to contraception in the context of a medical condition, perceiving pregnancy as dangerous or expressing concerns about the responsibilities of motherhood. In contrast, the women who experienced an unintended pregnancy after age 35 were more likely to (1) perceive themselves at lower risk of pregnancy, (2) report past experiences with unwanted contraceptive side effects or (3) report tentative partnerships.

Perceived Decreased Risk of Pregnancy

A number of the women who had an unintended pregnancy after age 35 did not perceive themselves as fertile and thus ceased using contraception. A 44-year-old woman named A.A. with 3 children did not desire more children. A.A. did not have a favorable view of birth control, and in particular, disliked the diaphragm because she felt it interfered with heightened sexual pleasure. A.A. wanted to forgo contraception and thought she could not get pregnant:

I thought that at my age that my fertility rate would be a lot lower. At 44, I’m going to be 45 in September. It’s unbelievable. I figured, I’m not going to get pregnant. I just got my period. I know it’s a safe time. Because I know ten days before your period and ten days after is a good time to know it’s safe. I was wrong.

A.A. believed she was not as fertile given that she was in her mid-40 s. She also mentions using periodic abstinence, but appears to have knowledge gaps regarding correct timing of the “safe” period.

D.F., aged 40, talked about how she is using the “rhythm method” (or periodic abstinence) as her choice of birth control. When asked why, she stated:

I think it’s a lot easier and I’m not taking medicine and putting things and chemicals into my system I really don’t need. And plus they say when you get over 35, once you’re over 40, your chances of getting pregnant decrease. It’s not that you can’t get pregnant, but the chances decrease. And I was taking birth control for so long, that I was just like, you know my body needs to rest. So I just stopped.

D.F. had two abortions after age 35. She said her unplanned pregnancies came from “laziness” and from “not taking a birth control method and umm, startin’ em and stoppin’ em.” D.F. had used condoms, pills and depot medroxyprogesterone (DMPA) in the past, but was unfamiliar with some of the newer methods, such as intrauterine contraception (IUC), patch and a monthly injectable contraceptive (which was available in the U.S. at the time of this study). To D.F., she had tried the gamut of available birth control methods, and periodic abstinence seemed like the safest, most hassle-free choice, particularly in light of her perceived low risk of pregnancy.

Unwanted Side Effects

Even when women were not seeking pregnancy, several respondents talked about the intolerable side effects that they experienced from birth control and as a consequence, stopped using them. J.K. was a 36-year-old woman who had had an unintended pregnancy less than one year prior to the interview. She talked about how she experienced bleeding after one injection of depot medroxyprogesterone (DMPA) given immediately postpartum: “I bled for almost two months….Oh my God. I mean constantly, nonstop I thought I was going to die. I mean, literally. I was wearing my baby’s Pampers. … t was ridiculous, and it was scary.”

J.K.’s negative experience with DMPA was a disappointment for her. She states that when she went back to her clinic to tell them about the bleeding, she was told the bleeding should stop and was not given any other options about what she could use. Although J.K. had already had several unintended pregnancies, the negative experience from the side effects of DMPA made her unwilling to continue the method. “It didn’t do like they said,” J.K. replies, and not knowing what other method to turn to, had another unplanned pregnancy soon after she discontinued this method.

Partnership

Unstable partnerships tended to negatively influence contraception use. This finding has been noted in other research studies. These women tended to view that being in love with their partners did not warrant contraceptive use, that the partnership alone justified the possibility of having another child. L.G. is a 43-year-old woman who had a recent unintended pregnancy. Prior to the unplanned pregnancy, L.G. and her husband were separated. They then got back together, and L.G. felt that contraception use was less important:

I don’t know HOW I had him . I just thought, I had probably have another baby (laughs lightly). I was going with .., you know, me and my husband started going having in and out, in and out, and then get back and I just said, ooh, what the heck .

L.G. is not thinking about her concerns about the responsibilities of motherhood, but rather the possibility that pregnancy may solidify her relationship with her husband.

When talking about her unplanned pregnancy two years prior, A.A. reports a similar theme regarding her hope for a fortified relationship:

I never wanted Lisa. I didn’t want to be pregnant. But I was happy I was pregnant because I was in love with the man I was with. Meaning I wanted it; however, I didn’t want to do it alone. Meaning I had reservations. I did, I was so happy because I was so in love with the father, maybe he’ll love me more that I have his child.

When asked if the love increased after the pregnancy and birth of “Lisa,” A.A. responds:

No. It never happened that way…. My expectations of having this child were more on getting the man than having the child, for me. You know, I was hoping, I’ll love it, and that he was going to love me more and I’m going to get him in the process. I really believed that. That was the first time I ever tricked… it wasn’t trickery but it was ‘I’m pregnant and boy…’ I kind of had an advantage, a leverage, as they say, women do these things. I did it too. And it didn’t work…. He didn’t come around the way I was expecting.

Despite this disappointment and the lack of desire for more children, A.A. was unable to shift her thinking about contraceptive use: “I had two abortions since Lisa. And I had one prior to that. So what does that tell ya? That I say it, meaning it was all with the father. I mean when I’m with this man that I love, I’m somewhere else mentally.”

M.G., a 35-year-old woman with three children who does not desire more children, explains her reaction to her last pregnancy, which occurred several months before the interview, as: “Oh Lord! not again.” But when asked about the events that led up to this unplanned pregnancy, she says:

I really wasn’t too big on birth control because I never really felt I needed birth control ’cause I was always with the same guy … I wasn’t worried about getting pregnant; it really didn’t matter one way or another, you know, if I was pregnant.

Women who had at least one unintended pregnancy after age 35 tended to view contraception as a hassle, something to avoid if not completely necessary, whereas many women who had avoided an unintended pregnancy after age 35 viewed contraception as something that protected them from the potential health hazard of pregnancy, alleviated a medical problem, or allowed them to avoid the responsibilities of motherhood.

Contraception Selection

Although some women were successful at using moderately effective contraceptive methods (such as condoms), the investigators asked the respondents about their perceived advantages or disadvantages of contraceptive methods they had used in the past, as well as those they had never used to better understand why more effective methods, such as intrauterine contraception (IUC) methods were not being used. Respondents framed their responses in the context of safety, efficacy, accessibility, ease or difficulty. Respondents appeared to have knowledge gaps with newer methods, such as the subdermal implant, monthly injectable, and contraceptive patch or ring because many had not used these methods, nor were familiar with them.

Perceptions that made respondents feel more favorable about selecting and using a method included spontaneity, ease, and accessibility.

Spontaneity

Both women with and without an unintended pregnancy after age 35 felt favorable about a contraceptive method that did not interfere with lovemaking. For example, K.T., a 40-year-old woman without an unintended pregnancy after age 35, talks about an advantage of the pill:

You don’t have to worry about putting any of that in prior. You can just be spontaneous. You don’t have to worry about, ‘oh wait just a second.’ You know, we’re in the heat of the moment. Let me run to the bathroom and put the diaphragm in. Or let me insert this vaginal contraceptive or something like that. You don’t have to worry about that.

Ease

Both women with and without an unintended pregnancy after age 35 felt favorable about easy and convenient methods and unfavorable about methods that were “technical” (such as the diaphragm) or involved “remembering” (such as the pill).

Accessibility and Service Barriers

Accessibility appeared to influence use. Most women perceived over-the-counter methods as accessible and easy to get. An exception to this was the pill, which was considered convenient if medical providers gave a one-year prescription. B.W., aged 35 woman and a history of unintended pregnancy after age 35, talks about the convenience of the male condom:

They are easy to get, and they’re free. If you choose to go the STD clinics or Planned Parenthood, they give you as many as you want. They are very easy. They have them in bathrooms, I understand… Very easy to obtain and reasonably priced.

Perceptions that tended to make respondents feel less favorable about selecting and using a method included being dangerous, costly and hard to obtain.

Dangerous

Most women felt unfavorably about methods that were perceived as harmful. Although most women who had not had an unintended pregnancy after age 35 reported intrauterine contraception (IUC) or the intrauterine device (IUD) as effective, many believed it causes pelvic inflammatory disease (PID). Some women who had had an unintended pregnancy after age 35 perceived IUC as hazardous; it was “internal” and had the potential to migrate somewhere else in the body. E.M., aged 49 with four children and no history of unintended pregnancy after age 35, does not have personal experience with IUC, but relays stories from friends:

I’ve had friends that used the IUD and maybe it was because it was fairly new, but it got embedded and they had to have surgery to get it out, and it just seemed like not a good thing to me. I was scared of that.

I.T., a 46-year-old without a prior history of unintended pregnancy after age 35 who is using the pill because she understands it will ease her menopausal symptoms, states: “I’ve heard that there are complications from … the IUD. I know someone who has a lot of problems with bleeding and other things. . .I guess it’s improved over the years. Um, so I’m not real familiar with the newer versions, but back in my 20’s I used to hear a lot of horror stories about it.”

G.R., a 39-year-old with three children and a history of unintended pregnancy after age 35, explains her apprehensions with intrauterine contraception, stating she “wouldn’t trust it.” When asked why, G.R. states: “I don’t know, it just don’t look right. Something might happen…like it will travel. You see, I mean you can’t keep something like that in place unless you inflate it, you know what I’m saying?”

Other respondents reported fears about chemically-based hormonal contraception as being potentially harmful. S.G., a 42-year-old woman without a history of unintended pregnancy after age 35, relates:

I would wonder what is this chemical, this drug or whatever that is, that is going into my body that is going to prevent me from getting pregnant that length of time. If it’s three months, for three whole months what in the world is this that I’m putting in my body?

Cost

Choosing a birth control method on the basis of cost was reported more often by those with no insurance or private insurance requiring co-pays than those with Medicaid. Two respondents reported unplanned pregnancy as a consequence of unaffordable birth control. D.F. is a 40-year-old woman with a prior history of unintended pregnancy after age 35. She states:

To be honest, $40 a month for contraception is impractical, I think immoral because most people can’t afford that. And that’s the insurance price. That’s a co-pay. So goodness knows how much these drugs are actually charged for at the pharmacies at full price. They don’t cost that much.

M.G., a 35-year-old woman with a prior history of unintended pregnancy after age 35, talks about the barriers she faced when paying for birth control: “I pay for the birth control stuff. When I got cut from my job I couldn’t pay for the . I made sure withdrew or used a condom. I got pregnant even though he withdrew.” M.G. paid out of pocket for birth control; cost limited her ability to use her preferred choice of an effective birth control method and she resorted to less effective methods, resulting in an unintended pregnancy.

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