contraception for women over 40

Question 1

in 2008, what was the rate of TOP in women aged 40-44?

Answer 1

4/1000

Question 2

what is the risk of Trisomy 21 in women aged 43?

Answer 2

1 in 40

Question 3

what are the UKMEC score for COC, depot and NET in women aged over 40?

Answer 3

UKMEC=2

Question 4

what are the most commonly used contraceptives in women >40?

Answer 4

sterilisation (her or partner)
pill
male condom
intrauterine methods

Question 5

which type of contraception may help with peri-menopausal symptoms?

Answer 5

combined hormonal contraceptive (CHC). can tri-cycle.

Question 6

what benefit does CHC confer for ovarian and endometrial cancer? how long do benefits last?

Answer 6

protective against ovarian, endometrial cancer. Protection continues for >15 years after stopping

Question 7

how does combined hormonal contraception affect risk of BENIGN breast disease?

Answer 7

reduction in incidence of benign breast disease. reduced risk hospitalisation with fibroadenoma /chronic cystic disease

Question 8

when does risk of breast cancer reduce back to baseline after stopping CHC?

Answer 8

small increase risk of breast ca with CHC.

reduces back to baseline 10yrs after stopping CHC

Question 9

what is UKMEC score for CHC if woman has FHx breast ca?

what is the scaore if the woman was carrier of BRCA gene?

Answer 9

UKMEC=1.
no increased risk of breast Ca using CHC.

if BRCA gene carrier- UKMEC=3 for CHC use

Question 10

what is the risk of cervical cancer when using CHC?

Answer 10

slight increase risk of Cx cancer with increased duration of CHC use. Risk returns to normal after 10 years of stopping

Question 11

what is the UKMEC recommendation for CHC use if you are >35, smoking >15cigs/day

Answer 11

UKMEC=4. increased risk of cardia/cerebrovascular disesase

Question 12

what is the UKMEC recommendation for CHC use if you are >35, smoking <15cigs/day

Answer 12

UK MEC= 3

Question 13

what is the UKMEC recommendation for CHC use if you are >35, ex-smoker of 1 year?

Answer 13

UK MEC= 2

Question 14

what are the increased risks of CHC if woman suffers with HTN?

Answer 14

increased risk of acute MI, stroke. Not VTE

Question 15

what is the UKMEC score for CHC use in those suffering with HTN, even if well controlled?

Answer 15

UKMEC=3

Question 16

if prescribing CHC in women over 40 with HTN, what monitoring should be undertaken?

Answer 16

check BP before and 6 mths after starting CHC.

starting dose of EE should be <30mcg

Question 17

what are the health benefits of Progesterone only contraception in women over 40?

Answer 17

1. may help with vasomotor Sx of menopause

2. may help with dysmenorrhoea (DSG pill/ implant/ depot inj)

Question 18

what are the risks to bone health with DMPA (depot injection)?
What is the UKMEC score for DMPA in >45

Answer 18

small reduction in bone density. recovers after discontinuation.
UKMEC=2 for DMPA in >45

Question 19

up tp what age can DMPA be given?

what assessment should be made before prescribing woman >45 DMPA injection

Answer 19

DMPA can be used in age up to 50.
assess for risk factors for osteoprorsis.
review every 2 years to assess benefits/risks

Question 20

which progesterone contraception has adverse effects on lipid metabolism?

Answer 20

DMPA

Question 21

what is the UKMEC score for progesterone only contraception for women who have had: stroke/ IHD/ risk factors for cardiovasc disease (smoking/ DM/ obesity/ HTN)

Answer 21

UKMEC= 3

don’t initiate or continue prog. contraception in women who have had stroke/ IHD.
POP/ mirena/ implant can be considered if woman has risk factors only

Question 22

what percentage women still ovulate when using mirena?

Answer 22

75%

Question 23

what advice should be given to women <50 using non-hormonal contraception who become amenorrhoeic?
what if she is >50?

Answer 23

if <50- stop contraception after 2 years of amenorrhoea.

if>50- stop contraception after 1 year of amenorrhoea

Question 24

which contraceptives are not recommended after the age of 50?

Answer 24

CHC, DMPA.

Change to POP/ mirena/ implant until age 55 or menopause confirmed

Question 25

can FSH be measured whilst still taking progesterone only contraception?

Answer 25

yes.

best to do after age 50 as morelikely to be menopausal

Question 26

which blood test can be used to confirm menopause?

Answer 26

if amenorrhoeic, check FSH and stop contraception if FSH >30 on 2 occasions more than 6 weeks apart

Question 27

if woman is using implant/ POP/ mirena over the age of 50, what advice should you give her if she is NOT amenorrhoeic?

Answer 27

continue until age 55.

if not amenorrheic at 55, consider Ix. Continue treatment until amenorrhoea for 1 year.

Question 28

if mirena was inserted at age45 or above, how long can it stay in for?

Answer 28

up to 7 years / menopause. whichever comes first

Question 29

if a woman under age 50 wants to stop her DMPA contraception, what advice would you give?

Answer 29

switch to non-hormonal contraception. This can be stopped AFTER 3 YEARS of amenorrhoea (usually 2 years with other hormonal contrceptions) due to potential delay in return to ovulation

Question 30

if mirena is in situ can estogen only HRT be used?

how frequently should the mirena coil be changed?

Answer 30

yes. estrogen only can be used.

mirena should be changed every 5 years- only provides endometrial protection for 5 years