Best Birth Control Options for Older Women How to Prevent Pregnancy in Your 40s and 50s

If you’re past 40 and think you no longer need to worry about contraception, you’re wrong! Many women in their 40s and 50s still need protection from unwanted pregnancy. Read on for expert advice about your best birth control options… Many women slack off on contraception when they reach midlife because they think it’s impossible for them to get pregnant anymore. “After 40, women may not have sex as often as they used to, plus they perceive themselves to be less fertile” – but that’s not always the case, says Victoria Jennings, Ph.D., director of Georgetown University’s Institute for Reproductive Health in Washington, D.C. Menstrual irregularities, including skipped periods, are also more common for women in their 40s and 50s, contributing to their false belief that they no longer need to take precautions, adds Andrew M. Kaunitz, M.D., professor and associate chairman of the department of obstetrics and gynecology at the University of Florida College of Medicine-Jacksonville. Fertility does decline with age, but if you don’t want to get pregnant – and choose not to undergo sterilization – you should use contraception until a full year has passed since your last spontaneous menstrual cycle, Kaunitz says. As you get older, however, the best birth control method for you may change. So if you’re heading past your 40th birthday, here’s a rundown of the top contraceptive options for older women, along with their pros and cons. Birth control options in your 40s and 50s: Combined oral contraceptive pills (the pill) How they work: The pill contains specific amounts of the hormones estrogen and progestin, which block ovulation and prevent fertilization. Pros and cons: The pill comes in various formulations, some of which can regulate your menstrual cycle, reduce its intensity and duration of flow, lessen cramps and decrease premenstrual syndrome symptoms, such as swollen or tender breasts, fatigue, headache or backache, joint or muscle pain, anxiety or depression. For maximum effectiveness, take your pill at roughly the same time every day. Common reported side effects include nausea, weight gain, decreased libido and headaches, but it isn’t clear to what extent (if any) the pill contributes to these. Who it’s for: The pill often is a good choice for women who are lean, healthy and don’t smoke. Women smokers on estrogen pills face a higher risk of blood clots, stroke, or heart attacks. The pill isn't for you if you have an underlying health condition that could be affected by estrogen, including obesity, high blood pressure, or a history of blood clots, migraine headaches or breast cancer. Reliability: 91%-97% Expert advice: “For lean, nonsmoking older women, the pill has [both] contraceptive and non-contraceptive benefits,” Kaunitz says. “It can reduce irregular perimenopausal bleeding and hot flashes and help prevent ovarian cancer. [It] may also decrease the risk of postmenopausal fractures [due to osteoporosis].” Birth control options in your 40s and 50s: Progestin-only oral contraceptives (the mini-pill) How they work: Mini-pills, which contain the hormone progestin but not estrogen, thicken cervical mucus and thin the uterine lining, preventing sperm from reaching and fertilizing an egg. Pros and cons: Mini-pills can make your periods shorter and lighter. However, they must be taken at the same time each day to be effective; you need to use a backup birth control method if you take mini-pills more than three hours late. Common side effects include unpredictable bleeding, weight gain or frequent yeast infections. The mini-pill also may increase the risk of ovarian cysts. Who they’re for: These can be a good choice for older women who can’t use estrogen-based contraception. Still, your doctor may caution against them if you have certain medical conditions. Reliability: 91%-97% Expert advice: “The mini-pill [is useful] for some older women, such as those who are overweight or continue to smoke,” Kaunitz says. Birth control options in your 40s and 50s: Vaginal ring How it works: A thin, transparent, flexible ring that you insert into the vagina yourself, the vaginal ring releases the same hormones as those in combination oral contraceptives, blocking ovulation and altering the uterine lining to prevent fertilization and implantation. You leave the ring in for three weeks, followed by a week off. Each vaginal ring is effective for one month. Pros and cons: Like the pill, the vaginal ring often makes periods more regular and may lessen cramps – both of which can be important for women approaching menopause. On the downside, it can increase vaginal discharge. Side effects are similar to those of combination oral contraceptives. Who it’s for: The vaginal ring is often a good choice for older nonsmoking women who have no underlying health problems. However, if you smoke or have a health condition that could be affected by estrogen – such as a history of breast cancer, migraine headaches or blood clots – the vaginal ring isn’t for you. Women who are obese or have high blood pressure should also avoid the ring. Reliability: 91%-97% Expert advice: “The vaginal ring is a fine birth control method for many older women,” Jennings says. “As with all estrogen-containing methods, though, there can be side effects, such as breakthrough bleeding, bloating and headaches. But side effects are just as likely in older women as in younger ones.” Birth control options in your 40s and 50s: Intrauterine device (IUD) How it works: When this small, T-shaped device is placed inside a woman’s uterus, it changes the uterine environment in ways that prevent sperm from reaching an egg or stop a fertilized egg from implanting. Two types of IUDs are available in the U.S.: ParaGard, which is hormone-free, and Mirena, which contains progestin. Both must be inserted and removed by a doctor. Pros and cons: IUDs can often stay in place for years at a time. ParaGard, which contains copper, may increase menstrual bleeding and cramping. Mirena can lighten or eliminate monthly periods, and it may be especially appealing to women with heavy bleeding problems. However, Mirena may cause acne or ovarian cysts in some women. Who it’s for: The IUD is an effective birth control method for most women, especially if they don’t want to take medication daily. It can be good for many women in their 40s and 50s, including those who are obese. Reliability: Better than 99% Expert advice: “The IUD is the best birth control method for women in their 40s and 50s, because if it’s placed at an appropriate age, they’ll be able to use it until they enter menopause,” says Natasha Withers, D.O., a family medical doctor at One Medical Group in New York City. “There are very few contraindications [or] side effects.” Birth control options in your 40s and 50s: Hormonal implant (Implanon) How it works: Implanon is a flexible, matchstick-sized rod that’s inserted under the skin of your upper arm. It releases a steady dose of progestin, which prevents fertilization. Pros and cons: Hormonal implants, which must be inserted and removed by a physician, can remain in place for as long as three years, so you don’t have to remember to take medication every day. Common side effects include irregular and unpredictable bleeding or spotting. Some women stop having periods while on Implanon. Who it’s for: Implanon is a good birth control method for most healthy women in their 40s and 50s. However, it can interact with some medications, including antibiotics. So tell your doctor about all prescription and over-the-counter drugs and supplements you’re taking. Reliability: 99% or better Expert advice: “Women with hormonal implants can achieve contraception as effective as sterilization without surgery, or the need to make irrevocable decisions,” Kaunitz says. Birth control options in your 40s and 50s: Condoms – male and female How they work: Condoms prevent pregnancy by creating a physical barrier to keep sperm from reaching an egg. Female condoms are inserted into the woman’s vagina. Both are available in different sizes. Pros and cons: Condoms don’t require a prescription and are widely available. Plus, they help protect against STDs. However, some older women may experience vaginal dryness during intercourse, so condoms may be uncomfortable unless accompanied by lubricant. (Avoid oil- or petroleum-based lubricants, because they can degrade the condom.) Condoms also can decrease sensation, and female condoms may be noisy. Some couples find them difficult to use correctly, which decreases their effectiveness. Female condoms may be difficult to find in stores but can be purchased online. Who they’re for: A lack of side effects makes condoms a good choice for many older women. Unless you’re in a committed relationship and are sure that neither partner has an STD, you should use condoms to protect against STDs – even if you’re past menopause or are also using another method of birth control, according to the National Institute on Aging in Bethesda, Md. Reliability: Male condom: 85%-95%; female condom: 79%-95% Expert advice: “Condoms aren’t just for teenagers,” Kaunitz says. “Mature women [are likely to] use condoms more consistently, and therefore more effectively, than younger women." Other birth control options The following are less frequently recommended for older women: Diaphragms and over-the-counter spermicides have a relatively high failure rate and generally aren't considered as effective as the top choices. Progesterone injections (Depo-Provera) may increase the risk of osteoporosis and weight gain, says Philip Baird, M.D., a family medicine doctor and birth control counselor at One Medical Group in New York City. The hormonal patch (Ortho Evra) causes higher levels of estrogen to circulate in the body compared with combination birth control pills. That may lead to a slightly higher risk of side effects. Be sure to discuss all your health conditions with your doctor when making decisions about birth control. To learn more about your contraceptive options, visit our Birth Control Health Center. Women's Health: How Much Do You Know? How you take care of yourself has a huge impact on your future, affecting everything from your ability to have children to your risk of heart disease. There's no substitute for good health, and when it's gone, it's often gone for good.