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Contraception in the over 40’s. Contraception in older women; issues  Method choice may be affected by age and risk factors.  When can the method be.

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Presentation on theme: "Contraception in the over 40’s. Contraception in older women; issues  Method choice may be affected by age and risk factors.  When can the method be."— Presentation transcript:

1 Contraception in the over 40’s

2 Contraception in older women; issues  Method choice may be affected by age and risk factors.  When can the method be discontinued?  How is the menopause diagnosed?

3 Typical scenario yr old Debbie, on progesterone only pill. Amenorrhoea 2+ yrs. Having some hot flushes, reduced libido, mood swings. She wonders if this may be due to the menopause. Can she have a blood test? Does she need to continue contraception?

4 Transition to menopause ( 40-50)  Intermittent ovulation/anovulation with variable FSH levels.  Cycle length may reduce or increase.  Amenorrhoea not a reliable indicator of menopause when using hormonal contraception  FSH levels; not an exact science!

5 Contraceptive method.  No method is contraindicated by age alone up to 50 yrs.  Some methods become less safe but this is dependent on other risk factors.  Need to use UKMEC guidance but if there are multiple risk factors this may affect advice.

6 Sexual health in the over 40’s

7 Sexual health in over 40’s  Average age divorce in women is 41 yrs.  New relationships common.  Conception rates in over 40’s more than doubled in 2 decades.  Older women may not be well informed regarding sexual health and contraception.

8 Abortion rates 2012, England and Wales  Age 40-44; 7737 abortions  Age 45-49; 662 abortions  Age 50 +; 27 abortions!

9 Method choice; Combined hormonal contraception  Use lowest dose that provides adequate cycle control; try to reduce to 20 mcg pill over 40.  May protect bone density  Likely to mask symptoms of menopause.  Careful consideration risk factors ( eg women with hypertension, UKMEC 3)

10 Method choice; Depo -provera  Caution in women with CV risk factors; high dose progesterone may have adverse effects on lipid metabolism.  This becomes UKMEC 2 in over 45’s  But remember need to follow MHRA guidance;  Re-evaluate risks and benefits every 2 yrs.  Assess osteoporosis risks; this may influence patient decision to continue.

11 When can contraception be stopped?  Menopause usually diagnosed after 1 yr amenorrhoea.  In general, CEU advised contraception may be stopped at age 55.  Non hormonal methods can be stopped 1 yr after LMP in 50+ yrs.  Non hormonal methods can be stopped 2 yrs after LMP if <50 yrs.

12 IUD/IUS; when to remove?  IUD inserted after age 40 can be left until menopause diagnosed ( >300mm copper)  If IUS inserted over age 45, may continue for up to 7 yrs or until menopausal if amenorrhoea.  IUS endometrial protection license for HRT; 4 yrs.

13 Diagnosing the menopause Debbie, 49, amenorrhoea on POP. Some menopausal symptoms. Women using PO methods ; FSH levels can be checked. If FSH>30 on 2 occasions, 6 weeks apart then contraception can be safely discontinued 1 yr later. Alternatively; just continue POP until 55, when natural loss fertility can be assumed for most women.

14 Women using CHC.  FSH is not a reliable indicator of ovarian failure in women using combined hormones, even if measured during the hormone-free interval.  At age 50 switch to non hormonal or PO method.  Prepare for the worst

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