For women who are approaching menopause, contraception often takes a back seat. These patients tend to assume that advancing age means decreasing fertility. Although fertility does dwindle as a woman gets older, that doesn't mean that premenopausal women in their late 30s and 40s can rely on this assumption as an adequate form of contraception. In fact, almost half of all pregnancies — and 75 percent of pregnancies in women over 40 — are unplanned.
IUD Use: Weighing the Benefits
This means it's important to discuss birth control for older women, as well as your younger patients. For women who are nearing menopause but still experiencing monthly periods, intrauterine devices (IUDs) are a good choice for contraception. IUD use in these patients can help protect against pregnancy without many of the potential risks associated with oral contraceptives and other hormonal forms of birth control.
When discussing IUD birth control for older women, consider the following pros and cons:
- Timing: Women who have an IUD inserted after age 40 don't have to deal with removal and replacement as frequently as younger women do. According to some experts, these patients can keep the same IUD until menopause. This suggests that IUDs may be the best birth control for over 40. The device should be removed two years after menstrual periods stop if this occurs before age 50, or one year after menstrual periods stop if this occurs after age 50.
- Heaviness of menstrual periods: Although IUD use can be a good contraceptive option for many women, they may cause menstrual periods to become heavier or more painful for some. Patients who already experience heavy or difficult menstruation may prefer another form of birth control, or opt for an IUD that releases progestin.
- Avoidance of hormones: Four of the five IUDs currently on the market release small amounts of progestin into a woman's body, while the fifth is hormone-free. In general, IUDs may be preferable to oral contraceptives because of this. Women who have breast cancer, are at increased risk of developing breast cancer, or have liver disease may want to avoid IUDs that release hormones.
- Efficacy: When IUDs are used correctly, the resulting risk of pregnancy over a year of use is less than one percent. That makes them an excellent choice for women who are serious about not getting pregnant.
- Placement: While the insertion of an IUD can cause some cramping and bleeding, most women won't experience any additional discomfort. Physicians can rely on 3D ultrasound imaging to ensure proper placement of IUDs.
Ultrasound
Despite the common misconception that older, premenopausal women are unlikely to get pregnant, rates of unintended pregnancy in this demographic are relatively high. So, when it comes to the best birth control for a 50-year-old woman, for instance, an IUD might be the answer. Don't miss an opportunity to talk about contraception options — and about IUD use in particular — with these patients.
