Contraception and midlife women: dispelling the myths

Why is there a scarcity of information on birth control as it pertains to the midlife women? In this blog, Dr. Gloria A Bachmann challenges outdated ideas about the safety of contraception for midlife women and argues for comprehensive contraceptive counseling and for not limiting choices being offered to midlife women before there is an individualized assessment of the risks and benefits of each method.

Remnants of the myth still exist that midlife women (variously defined as women between 35-65 years of age, or women born between 1952 and 1982) don’t need contraceptive counseling due to their decreased fertility (unlike adolescents and women up through their thirties). Also, there is often a belief among midlife women that they do not need safe birth control methods due to their decreased fertility and their increased health risks!  Both of these statements are not entirely true. Birth control in the midlife woman is essential, and before choosing a particular method, each midlife woman should be screened for risk factors in the same manner as any other woman.

But the real issue boils down to this: when are we going to shake off the false premise that most midlife women don’t need comprehensive counseling as part of their annual wellness exam?  Further, when are we going to get rid of the historical cobwebs of the 1960s that birth control pills aren’t safe for most midlife women? When are we going to objectively approach the topic of contraception in the midlife women?

The answer to the last query is now. The ongoing thematic series “Contraception and Pregnancy in Midlife: Complexities and Research Needs” published in Women’s Midlife Health is focused on this important topic and the fact that birth control in this population of women shouldn’t be an after-thought.

For those who would like some background on this issue, just Google “birth control in the 1960s.” Better yet, ask a clinician who practiced during that time period about midlife women using the birth control pill for contraception. What you would read and what practitioners would probably tell you is that midlife women (especially those over 40 years old) were particularly discouraged from using the Pill, as the dangers were said to usually outweigh the benefits. Today, the view that midlife women (regardless of their health status) should not be using the Pill or other systemic hormonal methods of birth control still detracts from midlife women using these birth control methods that may be best for them and their lifestyle.

These high dosages are unheard of today; in comparison, most pills today don’t exceed 35 micrograms of estrogen.

When birth control pills were first marketed, they had a much higher dose of synthetic estrogen and progesterone. These high doses were associated with more risks and more side effects. The first marketed pill, Enovid 10, had almost 10mg of progestin and 150 mg of mestranol, a synthetic estrogen. These high dosages are unheard of today; in comparison, most pills today don’t exceed 35 micrograms of estrogen.

It follows that with these high doses of hormones, there were more side effects and risks, including venous thromboembolism (VTE). For many years, clinicians prescribing the Pill were cautioned not to prescribe them to women over forty due to risk factors from these higher doses. However, we now know that many of the lower dose hormonal contraceptives are safe in healthy midlife women, and screening them to assess their contraceptive needs should be a part of their wellness evaluation.

Truly, it’s time to shake off the myths that most midlife women should not be using hormonal birth control. And the reasons include:

  • As discussed, Pills today have much lower doses of synthetic estrogens and progestins.
  • We understand true risk factors, especially for women who have a clotting problem, have had a previous stroke or VTE, have had an estrogen sensitive cancer and for those who smoke.
  • There are many systems to deliver low-dose hormones, including skin patches, vaginal rings, IUD’s, injectable systems and implantable systems if hormones are medically safe and preferred by the woman.

All women (especially over the age of 35) who are considering hormonal contraception should be screened for cardiovascular disease, including hypertension, smoking, diabetes, nephropathy, and other vascular diseases (including clotting issues and migraines) before use. It makes good sense not only for the use of contraception, but also for overall good health. Moving forward, all midlife women should be counseled about contraception and provided with all options, including hormonal ones, for effective family planning.

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