As we age, our bodies change!
This is particularly true in our late 40s. Our joints show the first signs of stiffness and start creaking; most of us need glasses for reading.
“I speak from experience. When writing this article, I am 48!”
From our mid-40s onwards, we enter peri-menopause. As we refer to it in South Africa, ‘the change of life.’
Believe it or not, this is a crucial time of your life to use contraception, and not just for the obvious reasons.
The benefits of birth control after 40 are vast, specifically the combined oral contraceptive pill (COC). Also known as ‘the pill,’ this birth control contains estrogen and progesterone.
“Most ladies think they need to stop the pill or take a rest from the hormones; however, taking breaks is not good.
These intervals between COC use are harmful, as they increase blood clotting risk.”
The risk of clots is highest in the first 12 months after starting the COC for the first time, especially in the first three months. If you stop the pill for more than a month, this resets to the baseline high.
Some low-dose oestrogen-containing COCs are safe to use up to the age of 55 as long as the patients:
- do not smoke,
- do not have a BMI > 30,
- have normal blood pressure,
- have no history of blood clots, and
- have no cardiovascular disease. 1,2
“The Centers for Disease Control and Prevention (CDC) also do not list age itself as a contraindication for COC.” 2 Bearing this in mind, you can continue the pill until menopause if you have no contra-indications.
So, what are the benefits of birth control after 40 years of age?
I will focus on the Combined Oral Contraceptive (COC) benefits.
Help transmission through menopausal symptoms
“The COC keeps a steady level of estrogen in your bloodstream. This masks the natural hormone drop and prevents the feared menopausal symptoms.”
You’ve all heard about the dreaded hot flushes and night sweats—low levels of the female hormone estrogen cause these symptoms.
As you age, so do your ovaries. As they wrinkle and shrivel, they produce less estrogen. This can happen anywhere from 45 years of age.
Photo by cottonbro studio: https://www.pexels.com
Cycle regulation
Other signals that menopause is on the horizon are menstrual cycle changes.
These could present in various ways:
- Infrequent or unpredictable cycles,
- heavy or continuous bleeding, and
- severe period pains.
“The above symptoms are an inconvenience that the COC can regulate.”
Photo by Nadezhda Moryak: https://www.pexels.com
Late-onset acne control
“Were you a pimply adolescent? Hormone-related acne and skin changes can also occur as you approach menopause.”
As you might know, we prescribe COC as an acne treatment for teenagers. A low-dose COC through your 40s might prevent hormonal perimenopausal acne.3
Cancer prevention
Combined oral contraceptives use can protect you against cancer.
“You’ve read correctly. They already offer menopausal symptom, cycle and acne control, but also may prevent cancer.
I agree; it does sound too good to be true.”
In fact, the longer you use them, the better for lowering ovarian and endometrial cancer risk.
In addition, protection against these cancers continues for up to 10 years after stopping the pill. 4,5,6
Let’s review the statistics.
Image by Teyssier Gwenaelle from Pixabay
Endometrial cancer protection
Some of you may be asking, “What is endometrium?” It is the specialized lining of your womb. It thickens every month, then breaks down and bleeds out if you don’t fall pregnant in that cycle.
The statistics for protection against endometrial cancer are mind-blowing. 50% reduction with four years of use, up to approximately 70% with 12 years of use. 4,5,6
Ovarian cancer protection
A decrease of 20% for each five years of use; approximately 50% reduction after 15 years. 4,5,6
Colon cancer protection
Women who have used COC at any stage of their lives have a lower risk for colon cancer than those who haven’t. 5,7
What about breast and cervical cancer?
So, everyone agrees about the pill’s endometrium, ovary, and colon cancer protection.
What about other female organs?
“I cannot find a consensus about whether the risk increases significantly for breast and cervical cancers. Some studies quote zero risk, and others a 7% increase, with results difficult to evaluate.” 1,2,5,6
The sources do agree that any risk reverses after stopping the COC.
I do not think this uncertainty should put you off the pill during perimenopause unless you have a family history of breast cancer.
Photo by cottonbro studio: https://www.pexels.com
Both breast and cervical cancers are routinely screened for; endometrial, ovarian, and colon cancer are not.
Awareness campaigns remind us about breast checks, mammograms, PAP smears, and HPV testing.
“In my opinion, the protection against endometrial, ovarian, and colon cancer outweighs the speculated risk for breast and cervix.”
Prevent unplanned pregnancy
“This is the most important of the benefits of birth control after 40, even though I am listing it last.”
There is a misconception that you are not fertile after 40. 1,8 There is no accurate way of testing whether you are still fertile.
“In 20 years of GP practice, I saw, on average, one unplanned pregnancy a year in patients older than 40. Two of these ladies were in their 50s.”
Advanced maternal age is classified as pregnancy over 35 years old. From your late 30s, things get more complex for mom and her baby.
After 40, unplanned pregnancies put mom and baby at a higher risk of complications. 9,10
Prevent risks to the mother
“At 45, you are more worn and torn than in your 20s. It makes sense that the risk of things going wrong is higher.”
Some of these potential complications are:
- High blood pressure (BP)
- Pre-eclampsia (very high BP affecting the kidneys)
- Diabetes starting in pregnancy
- Placenta praevia (a placenta that covers the birth canal)
- Increased chance of twin pregnancy
Prevent risks to the baby
- Low birth weight
- Stillbirth
- Miscarriage before 24 weeks
- Autism spectrum disorder (ASD) 11
- Chromosomal abnormalities, e.g., Down Syndrome
Down syndrome is an excellent illustration of this increased maternal age to increased risk ratio. 12
- 30 years old = 1/1000 pregnancies
- 35 years old = 1/400 pregnancies
- 40 years old = 1/100 pregnancies
- 45 years old = 1/30 pregnancies
Image by Megan Rexazin from Pixabay
Summing it up
- Combined oral contraceptives (COC) fulfill all the listed benefits of birth control after 40.
- The most important benefit is preventing unplanned pregnancy and its associated complications.
- Protect yourself against cancers that are not routinely screened for.
- Transition smoothly through perimenopausal hormone fluctuations.
- If you have contraindications to COC or know it is not for you, choose another form of contraception during menopause. Other options are sterilization or convincing your partner to ‘get the snip’!
- Taking a break from the COC is dangerous as it increases your risk for blood clots.
- If you are on a COC after 40, have a full check-up to assess your cardiovascular risk factors annually. Your GP or gynae will decide at this visit if it is still appropriate for you to continue.
References
- Allen, R. H., Cwiak, C. A., & Kaunitz, A. M. (2013). Contraception in women over 40 years of age. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 185(7), 565–573. https://www.cmaj.ca/content/185/7/565
- Cho M. K. (2018). Use of Combined Oral Contraceptives in Perimenopausal Women. Chonnam medical journal, 54(3), 153–158. https://doi.org/10.4068/cmj.2018.54.3.153
- Khunger, N., & Mehrotra, K. (2019). Menopausal Acne – Challenges And Solutions. International journal of women’s health, 11, 555–567. https://doi.org/10.2147/IJWH.S174292
- Grimbizis, G. F., & Tarlatzis, B. C. (2010). The use of hormonal contraception and its protective role against endometrial and ovarian cancer. Best practice & research. Clinical obstetrics & gynaecology, 24(1), 29–38. https://doi.org/10.1016/j.bpobgyn.2009.08.010
- Oral contraceptives (birth control pills) and cancer risk. National Cancer Institute. (n.d.). https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet#:~:text=Endometrial%20cancer%3A%20Women%20who%20have,contraceptives%20were%20used%20(13)
- Burger, C. W., Bouwma, A. E., Stellingwerff, G. C., & Kenemans, P. (1994). ‘De pil’ en kanker van de vrouwelijke geslachtsorganen en de mamma [The pill and cancer of the female sex organs and breast]. Nederlands tijdschrift voor geneeskunde, 138(1), 16–21.
- Murphy, N., Xu, L., Zervoudakis, A., Xue, X., Kabat, G., Rohan, T. E., Wassertheil-Smoller, S., O’Sullivan, M. J., Thomson, C., Messina, C., Strickler, H. D., & Gunter, M. J. (2017). Reproductive and menstrual factors and colorectal cancer incidence in the Women’s Health Initiative Observational Study. British journal of cancer, 116(1), 117–125. https://doi.org/10.1038/bjc.2016.345
- Centers for Disease Control and Prevention. (2023, March 27). When women can stop using contraceptives . Centers for Disease Control and Prevention. https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/stop_using_contraceptives.html#:~:text=Although%20uncommon%2C%20spontaneous%20pregnancies%20occur,years%20(333%2C334)
- Bouzaglou, A., Aubenas, I., Abbou, H., Rouanet, S., Carbonnel, M., Pirtea, P., & Bernard Ayoubi, J. M. (2020). Pregnancy at 40 years Old and Above: Obstetrical, Fetal, and Neonatal Outcomes. Is Age an Independent Risk Factor for Those Complications? Frontiers in Medicine, 7. https://doi.org/10.3389/fmed.2020.00208
- NCT (National Childbirth Trust). (2020, January 8). Pregnancy and birth for women over 35: Pregnancy articles & support: NCT. NCT (National Childbirth Trust). https://www.nct.org.uk/pregnancy/tests-scans-and-antenatal-checks/pregnancy-and-birth-for-women-over-35
- Lyall, K., Song, L., Botteron, K., Croen, L. A., Dager, S. R., Fallin, M. D., Hazlett, H. C., Kauffman, E., Landa, R., Ladd-Acosta, C., Messinger, D. S., Ozonoff, S., Pandey, J., Piven, J., Schmidt, R. J., Schultz, R. T., Stone, W. L., Newschaffer, C. J., & Volk, H. E. (2020). The Association Between Parental Age and Autism-Related Outcomes in Children at High Familial Risk for Autism. Autism research : official journal of the International Society for Autism Research, 13(6), 998–1010. https://doi.org/10.1002/aur.2303
- British Pregnancy Advisory Service. (2015). What’s the problem with older mothers? BPAS. https://www.bpas.org/get-involved/campaigns/briefings/older-mothers/
