Contraception for Women >40

Question 1

All methods are UKMEC1 in older women except which two methods?

Answer 1

• CHC UKMEC 2 >=40
• DMPA UKMEC 2 >45

Question 2

When do you advise stopping contraception in women >50 on non-hormonal contraception?

Answer 2

Stop contraception after 1 year of amenorrhoea

Question 3

When do you advise stopping contraception for women under 50 on non-hormonal contraception?

Answer 3

Stop contraception after 2 years of amenorrhoea

Question 4

When may CHC be beneficial in women >40?

Answer 4

In peri-menopausal women, CHC may help maintain bone mineral density and reduce menopausal symptoms.

Question 5

What can CHC cause in peri-menopausal women?

Answer 5

Flushes and sweats during the HFI. Can advise reducing the HFI to 4 days or using an extended regimen to alleviate symptoms.

Question 6

What should you advise in terms of dosing of COCP for women >40?

Answer 6

• Prescribe the lowest possible dose of oestrogen (<30mcg ethinylestradioal or an oestradiol-containing CHC) along with levonorgestrel or norethisterone
• Recommended due to lower risk of VTE, cardiovascular disease and stroke

Question 7

At what age is a woman on CHC advised to change to a progestogen-only method as the risks associated with CHC use outweigh the benefits?

Answer 7

50 years old

Question 8

At what age may women stop contraception as it is exceptionally rare for spontaneous conception to occur at this age?

Answer 8

55 years old

Question 9

What age should depo-provera be discontinued?

Answer 9

50 years old - switch to non-hormonal or POP

Question 10

What should you advise women >40 taking the depo-provera?

Answer 10

• There may be a delay in return of fertility up to 1 year
• Associated with a small loss in bone mineral density, usually recovered after discontinuation

Question 11

What should you check in women >50 years old wanting to stop contraception on progestogen-only methods?

Answer 11

• If amenorrhoeic, check FSH
• If FSH >30 IU/L, contraception can be discontinue in 12 months’ time
• If FSH <30 IU/L then repeat FSH in 12 months’ time
• Can just stop if >=55
• If not amenorrhoeic (after 50), consider investigating for abnormal PV bleeding

Question 12

Can HRT be used for contraception?

Answer 12

NO

Question 13

Which contraception method is licensed to provide the progestogen component of HRT?

Answer 13

Mirena

Question 14

Can POP be used in conjunction with HRT?

Answer 14

YES
- POP can be used as contraception on top of HRT
- POP is not licensed to be used as HRT as does not protect the endometrium

Question 15

Up till when can the IUD be used as contraception in >40s?

Answer 15

IUD inserted after age of 40 can be used until contraception is no longer required, or 1 year after the menopause in the over 50s

Question 16

Up till when can the Mirena be used as contraception in >45s?

Answer 16

A Mirena fitted for contraception after the age of 45 can remain in place until a woman is 55. Removal after this time is recommended as there is potential risk that the IUC may become a focus of infection.