Contraception >40yo

Question 1

Contraception > 40yo:

Why its different?

Answer 1

There is an increased background risk of

• VTE
• Breast Ca
• Endometrial carcinoma
• osteoporosis

hence avoiding methods that increase the risk is ideal

Question 2

Contraception > 40yo:

Options?

Answer 2

implanon, minipill and Mirena - all have no influence on VTE, CVA, MI, osteoporosis risk

Copper IUD

COCP (reduced endometrial and ovarian cancer risk)

• must contain levonorgestrel or northisterone as they have the lowest VTE risks
• not used above age 50yo UNLESS low risk women as MHT alternative

Question 3

Contraception > 40yo:

When does contraception need consideration?

Answer 3

If perimenopausal and >55yo then spontaneous conception is rare

Question 4

Contraception > 40yo:

IUD considerations?

Answer 4

Mirena

• if inserted ≥45yo - remains until 55yo
• IF for endometrial protection (as in MHT) not for contraception then replaces 5 yearly*
• Kyleena can be used for contraception alone NOT MHT
• Mirena placed for HMB can stay for up to 7 year*

Copper
-if inserted ≥40yo - remains until 1 year after last period after 50yo