Appropriate contraception for middle-aged women

Abstract

The United States Food and Drug Administration and the International Planned Parenthood Federation recommend that women over the age of 40 should utilize forms of contraception other than the pill. This decision was reached as a result of the 1975 clinical papers by Mann and his associates (Mann et al., 1975; Mann & Inman, 1975) and the epidemiological reports of the Royal College of General Practitioners (1977), Mann, Inman & Thorogood (1976) and Vessey, McPherson & Johnson (1977). Several authoritative bodies believed it prudent to suggest that the age limit for oral contraceptive use be lowered to 35, and even to 30 years (Anon, 1977; Planned Parenthood memorandum, 1977). The investigations of Inman & Vessey (1968) point to a precarious rise in mortality figures for women over age 35 on oral contraceptives.

Contraception for the older woman

“…Excellent results were obtained both in amelioration of incidental symptoms in premenopausal patients and as a contraceptive. Cardiovascular morbidity did not occur in this limited series and Greenblatt (1982) attributed this to the use of natural oestrogens. The method deserves a more extensive trial.…”

“…For the older woman with menstrual problems that have been investigated, it provides a short-term eflective method of contraception and menstrual control and may well be useful in those awaiting hysterectomy where the delay in hospital admission is long. Greenblatt (1982) has investigated the effects of varjous doses of oestradiol implants in premenopausal women. The patients were between 35 and 50 years of age and were given doses ranging from 100mg to a maintenance dose of 25 mg after 1 year of therapy.…”

Contraception in women over forty

“…Condoms are liable to be regarded as unsatisfactory because, for example, they are 'less than aesthetic and often inconvenient' (Greenblatt, Nezhat & McNamara, 1979). They are rarely mentioned as appropriate contraception for older women and are 'seldom prescribed and used today ' (Stone, 1976).…”

Effects of subcutaneous oestradiol implants on ovarian activity

“…1977), and one during the maintenance dose of 25 mg oestradiol (Greenblatt et al 1979). The authors therefore recommended that alternative methods of birth control should be used for at least the first cycle after the start of hormone implantation, although two of the four early conceptions occurred after that time.…”