Which birth control pills are best to choose after 40 years of age?

Women's health after 40 years

After 35 years, the natural death of immature eggs accelerates 2-3 times, so after 40 many cycles become anovulatory. Menopause occurs on average at 50-55 years of age, but in some cases menstruation may stop as early as 45 (see pills after 45 years). It is important to choose a contraceptive method that will not harm your hormonal levels.

By the age of 40, diseases that are associated with poor lifestyle, bad habits and gradual aging accumulate in the body. When visiting a doctor, most women find:

• uterine fibroids - according to statistics, taking into account the asymptomatic form, it occurs in 50-70% of women;
• endometriosis – occurs in every 10 women;
• endometrial hyperplasia - according to various sources, is observed in the majority of women with fibroids and endometriosis, the prevalence reaches 60%;
• mastopathy – in various forms occurs in 20-60%.

Metabolic disorders in older age lead to obesity, the development of hyperandrogenism, diabetes mellitus, and thyroid pathology is common. Therefore, many patients complain of irregular menstrual cycles, bleeding and other signs of impaired hormone production.

We make our own decisions

A woman must independently decide whether she still wants to have children after 40-45 years. To do this, you need to weigh all the positive and negative sides of such an act, because the female body does not get younger, chronic diseases are accompanied by a decrease in the quality of the biomaterial.

Taking contraceptives prescribed by a doctor will help eliminate unwanted pregnancy, because having an abortion at any age is dangerous, and for people over forty, the risks increase several times.

Date of publication: January 17, 2018

31210 0 0

Types of birth control pills after 40 years

Choosing birth control pills after 40 years is more difficult due to the large number of contraindications. But it is impossible to completely abandon birth control methods; few people agree to bear and give birth to a child at this age. Hormonal agents have been developed that are suitable for late reproductive age, which reliably protect against pregnancy and help stabilize the course of diseases associated with increased concentrations of estrogen.

Hormonal agents

Contraceptives for a 40-year-old woman can be produced in various combinations of hormones:

• combined oral contraceptives based on estrogens and gestagens;
• pure gestagenic drugs.

The first group of contraceptives is more popular. Single-phase contraceptives can be used with good control of the menstrual cycle, but microdoses are more often accompanied by intermenstrual bleeding. Therefore, preference is given to low-dose ones with 30 mcg of estrogens.

Hormonal drugs with gestagens after 40 can be prescribed if the estrogen component is contraindicated. More often these are women with hypertension, diabetes and obesity.

Attention! Estrogens increase blood viscosity, so COCs are not recommended for those with a tendency to thrombosis, migraines, and a history of cerebrovascular accidents.

Non-hormonal with phytoestrogens

Some patients are afraid that hormones will make them gain weight or other undesirable effects of oral contraceptives will appear. Therefore, they ask the gynecologist to prescribe herbal remedies with phytoestrogens. These are preparations that contain black cohosh extract. It has been proven that the active substance can replenish the signs of estrogen deficiency and reduce the first manifestations of menopause symptoms, but they do not protect against pregnancy. This is due to the fact that the contraceptive effect is provided by progestins, and their analogues have not been found in plants.

Emergency contraception

After 40 years, you can use an emergency method of birth control, with caution and taking into account contraindications. Birth control medications include levonorgestrel or mifepristone. These substances prevent fertilization or implantation of the fertilized egg into the uterine wall, but they are not capable of causing early abortion. There is also a risk of menstrual cycle disruption. Therefore, you need to resort to this method of protection against pregnancy as rarely as possible.

Criteria for choosing contraceptives after 40 years

Contraceptives after 40 years are selected based on the patient’s medical history. Absolutely healthy women are prescribed a low-dose drug that contains ethinyl estradiol and any gestagen with low androgenic activity: norgestimate, levonorgestrel, desogestrel, gestodene. In other cases, the following indicators are taken into account:

• for endometriosis - contraceptives with antiandrogenic progestins;
• in case of weight gain, tendency to edema in the second phase of the cycle - contraceptives with drospirenone;
• for controlled diabetes mellitus - a dose of estrogen of 20 mcg, so as not to increase the risk of thrombosis;
• menstrual irregularities when using contraceptives in the past - three-phase contraceptives;
• for dysmenorrhea, dysfunctional bleeding - contraceptives with a pronounced gestagenic effect: Femoden, Janine.

Attention! If you do not follow the recommendations for making the right choice, the risk of side effects increases.

How do oral contraceptives affect libido?

According to some studies, the level of sexual desire and pleasure in women who take COCs, although not significantly, decreases [3]. The explanation for this is this: the pills change the level of not only estrogen and progesterone, but also androgens - these hormones are responsible for the receptivity of the psychosexual areas of the central nervous system. However, only 15% of women report such negative side effects. In addition, it is impossible to unambiguously associate the level of androgens with sexual desire, since for some, libido decreases when taking pills, while for others it remains the same. The psychological factor should not be discounted. Having ceased to be afraid of an unwanted pregnancy, a woman can, on the contrary, begin to have sex more often and more willingly. Libido also directly depends on the phase of the cycle. The peak of desire usually coincides with ovulation.

Features of the selection of contraceptive drugs after 40

After 40 years, oral contraceptives are selected taking into account the woman’s age and the likelihood of early menopause. Sometimes menstruation stops as early as age 45, which corresponds to early menopause. If this happens at 40, this is premature menopause.

Premenopausal

You can protect yourself after 40 years with the help of estrogen-progestin drugs, but the dosage is selected carefully. The condition of the mammary gland is taken into account and an ultrasound is performed. If, based on the results, there is a suspicion of a neoplasm, hormones should not be used. They increase the risk of breast cancer progression.

In case of menstrual irregularities, frequent dysfunctional bleeding, it is necessary to establish their cause. After 40, the incidence of cervical, endometrial and ovarian cancer increases sharply . These diseases may be accompanied by acyclic bleeding, but contraceptives are contraindicated.

It is also necessary to take into account the severity of the symptoms of approaching menopause, which is why birth control pills are often used in premenopause as a component of hormone replacement therapy.

During menopause

Menopause is the period in a woman's life after her last menstruation; it is called menopause and is determined retrospectively. If there are no periods during the year, it is considered that menopause has occurred. The function of the ovaries is completely suppressed, they practically do not produce estrogens, and eggs do not mature in them. Therefore, there is no need for contraception.

During this period, hormonal drugs are used for replacement therapy to alleviate the signs of estrogen deficiency. But synthetic ethinyl estradiol is prohibited; natural estrogen is needed. The use of non-hormonal herbal remedies is allowed.

For smokers

After 35 years of age, the risk of developing thrombotic complications increases when using contraceptives. Women who smoke have a significantly higher risk of thrombosis. Therefore, after 40 years of age, methods of contraception without the use of hormones are recommended. These can be disposable condoms, spermicides, but pure gestagens are allowed.

“Bonuses” of KOCs

• ensure the establishment of a regular menstrual cycle [9],
• reduce blood loss, reduce the severity of anemia caused by heavy uterine bleeding
• significantly reduce hot flashes, sweating and other unpleasant symptoms of perimenopause [4].

Sometimes contraceptives are prescribed during perimenopause specifically to eliminate unpleasant symptoms. In this case, it is important to remember that hormonal therapy prescribed for this purpose may not provide the desired contraceptive effect if the dosage regimen is not followed or, for example, if you smoke. [eleven]

Rating of the best birth control pills after 40 years

In the review of contraceptives allowed at age 40, the leading positions are occupied by drugs that help cope with heavy menstruation, regulate the cycle and prepare the body for menopause. But women should be regularly monitored by a doctor, be examined by a gynecologist at least once a year, and have a smear for oncocytology.

No. 1 Klaira

According to many researchers, after 40 years, these are the best birth control pills for mature women. This is the first modern contraceptive drug that contains natural estrogen. Therefore, they provide protection against pregnancy, control the menstrual cycle well, and help prepare the body for the transition to hormone replacement therapy. The price of packaging for 1 and 3 months is 1015-2850 rubles.

No. 2 Janine

The contraceptive drug contains ethinyl estradiol and gestaden. This component has a pronounced progestogenic effect, so the tablets are recommended for women with dysfunctional bleeding, frequent cycle disruptions, and oligomenorrhea. Janine is available in 21 tablets per package, so when using, a break of 7 days is required. Package cost from 940 rub.

No. 3 Mercilon

The tablets are a combination of ethinyl estradiol and desogestrel, which has a weak gestagenic effect. It does not increase the sensitivity of hair follicles to androgens and does not lead to an increase in the concentration of male hormones. Therefore, contraception is recommended for women who develop signs of hirsutism. The cost of a pack for 21 days is from 1300 rubles.

No. 4 Lactinet

These are contraceptives for women over 40 years of age with new generation obesity; they do not increase the risks of vascular complications or thrombosis. Therefore, they can be used in cases where estrogens are prohibited. Contains desogestrel in the minimum dose required to protect against pregnancy. The cost of tablets is 500-750 rubles.

No. 5 Regulon

Contraceptive pills contain synthetic estrogen and desogestrel. It does not have andogenic properties, so it can be used after 40 years for contraception and maintenance treatment for endometrial hyperplasia. Available in 21 tablets in a blister, the cost of one is from 370 rubles.

No. 6 Silest

Birth control pills contain norgestimate, which has a pronounced gestagenic effect. It is necessary in women with dysfunctional bleeding and oligomenorrhea. But it is not recommended if you are prone to hirsutism and acne . But the drug is not popular among doctors and patients, so it is difficult to buy.

No. 7 Tri-regol

A three-phase contraceptive based on ethinyl estradiol and levonorgestrel. Indicated for women with poor cycle control and signs of estrogen deficiency. Birth control also helps to cope with other signs of estrogen deficiency - decreased libido, vaginal dryness. The cost of packaging is on average 300 rubles.

No. 8 Triquilar

An estrogen-gestagen three-phase contraceptive drug is also recommended for symptoms of female hormone deficiency in women over 40. There are 21 tablets in the package, after finishing it a break of 7 days is required, during which menstrual-like bleeding is observed. The price of a package is on average 600 rubles.

No. 9 Exluton

The tablets are a monocomponent hormonal contraceptive based on linestrenol. This is a gestagen that is recommended for use by women with menstrual irregularities, but without signs of hyperandrogenism, as well as with contraindications to estrogens. The cost of tablets is from 3400 rubles.

No. 10 Yarina

A modern contraceptive drug that contains drospirenone, a progestogen that allows you to control the menstrual cycle, as well as get rid of swelling and weight gain in the second phase. It is recommended for women with signs of hirsutism associated with hyperandrogenism. Packaging costs from 1000 rubles. per month up to 3400 for 3 cycles.

No. 11 Belara

A combination of ethinyl estradiol and chlormadinone, which has an antiandrogenic effect. Birth control pills are recommended for symptoms of excess male hormones and polycystic ovary syndrome. This is a good alternative if the drug with drospirenone or dienogest is not suitable. Price from 600 rub.

Sources

• Tadele A., Berhanu M. Trends and influencing factors of long-acting contraceptive utilization among contraceptive users in Ethiopia: repeated cross-sectional study. // BMJ Open - 2021 - Vol11 - N1 - p.e037103; PMID:33441349
• Skracic I., Lewin AB., Steinberg JR. Types of Lifetime Reproductive Coercion and Current Contraceptive Use. // J Womens Health (Larchmt) - 2021 - Vol - NNULL - p.; PMID:33404346
• Pearce E., Jolly K. Emergency Oral Contraceptive Consultations in Pharmacies in a Rural Setting: An Epidemiological Analysis. // J Pharm Pract - 2021 - Vol - NNULL - p.897190020961698; PMID:32990131
• Demir O., Ozalp M., Sal H., Aran T., Osmanagaoglu MA. Evaluation of the frequency of coitus interruptus and the effect of contraception counseling on this frequency. // J Obstet Gynaecol - 2020 - Vol - NNULL - p.1-6; PMID:32543257
• Gyllenberg F., Saloranta T., But A., Gissler M., Heikinheimo O. Predictors of choosing long-acting reversible contraceptive methods when provided free-of-charge - A prospective cohort study in Finland. // Contraception - 2021 - Vol101 - N6 - p.370-375; PMID:32061566
• Mugore S. Exploring Barriers: How to Overcome Roadblocks Impeding the Provision of Postabortion Care to Young People in Togo. // Glob Health Sci Pract - 2021 - Vol7 - NSuppl 2 - p.S342-S349; PMID:31455629
• Gyllenberg FK., Saloranta TH., But A., Gissler M., Heikinheimo O. Induced Abortion in a Population Entitled to Free-of-Charge Long-Acting Reversible Contraception. // Obstet Gynecol - 2021 - Vol132 - N6 - p.1453-1460; PMID:30399102
• Liu J., Schatzkin E., Omoluabi E., Fajemisin M., Onuoha C., Erinfolami T., Ayodeji K., Ogunmola S., Shen J., Diamond-Smith N., Sieverding M. Introducing the subcutaneous depot medroxyprogesterone acetate injectable contraceptive via social marketing: lessons learned from Nigeria's private sector. // Contraception - 2021 - Vol98 - N5 - p.438-448; PMID:30071196
• van der Straten A., Agot K., Ahmed K., Weinrib R., Browne EN., Manenzhe K., Owino F., Schwartz J., Minnis A. The Tablets, Ring, Injections as Options (TRIO) study: what young African women chose and used for future HIV and pregnancy prevention. // J Int AIDS Soc - 2021 - Vol21 - N3 - p.e25094; PMID:29600595
• Brandi K., Woodhams E., White KO., Mehta PK. An exploration of perceived contraceptive coercion at the time of abortion. // Contraception - 2021 - Vol97 - N4 - p.329-334; PMID:29253582

Rules for taking contraceptives after 40 years

Women of older reproductive age must adhere to the general principles of contraceptive use. But for them, a continuous regimen is allowed, when the tablets are taken for 3 months in a row, only after that they take a break for 7 days. Then the course is resumed. This scheme helps to reduce the manifestations of hyperplastic processes and reduce the thickness of the endometrium.

How long you can use birth control pills depends on your overall health. If after 40 years there are signs of imminent menopause, you need to take hormones for no more than 5 years. In other cases, you need to switch to hormone replacement therapy after age 50.

Contraindications and side effects to drugs

When the body begins to age, the number of diseases that lead to the appearance of pathologies of the blood vessels and endocrine system increases. Therefore, you need to be careful about contraindications for using contraceptives:

• arterial hypertension;
• uncontrolled diabetes mellitus;
• migraine;
• suffered a stroke, heart attack and other circulatory disorders;
• history of thrombophlebitis;
• bleeding disorders;
• oncological diseases;
• bleeding of unknown origin.

While using contraceptives, undesirable effects may occur that will require replacing the drug or discontinuing it:

• soreness of the mammary glands;
• intermenstrual bleeding;
• vaginal dryness;
• decreased libido;
• mood swings;
• weight gain and swelling;
• scanty or heavy menstruation;
• pain in the calf muscles.

A sharp headache, difficulty breathing, stabbing pain in the heart are a sign of severe pathology. This requires emergency medical attention.