Contraception for the woman aged 35 yr and over

Abstract

Women 35 years old must choose their contraceptive method by balancing between an acceptable failure rate and manageable side effects. In Birmingham, England, 1985 data show that among those women 35 years old, 28.8% chose oral contraceptives (OCs), 38% IUDs, 31.1% barrier methods, and 2.1% other methods. The incidence of irregular menstrual cycles, luteal phase deficiency, and short cycles increases with age. On the other hand, the frequency of intercourse declines with age thereby reducing fertility. These and other factors increase couples' anxiety about pregnancy as they grow older therefore establishing a need for adequate and informed counseling concerning all available contraceptive methods. Any counseling on choice or change of method should start before age 35 to allow the couples to make a logical choice based on their needs. Individuals must 1st consider the risk factors of combined OCs, especially smoking, obesity, and family history of cardiovascular diseases, before agreeing to use them. Progestogen only OCs provide a safer alternative. The IUD provides effective protection from pregnancy with minimal side effects, particularly copper IUDs. The death rate/year for IUDs for women 35-39 years old is 2/100,000 compared to 13.4 for smoking OC users, 4.5 for nonsmoking OC users, 5 for users of barrier methods, and 20.8 for women using no method at all. Since fertility declines with age, many women may choose barrier methods, but must realize that the chance of conception is higher than for the other methods and therefore must consider postcoital contraception or abortion. Sterilization is a popular contraceptive method for these women, but they should receive adequate counseling before the operation.