Contraception for Women Over 40

Introduction to Contraceptive Options

The U.S. Medical Eligibility Criteria classifies combined hormonal contraceptives for women ≥40 years as Category 2, meaning the advantages generally outweigh theoretical or proven risks, according to the U.S. Medical Eligibility Criteria 1, 2, 3
The American College of Cardiology recommends that cardiovascular disease risk increases with age and may be further increased with CHC use, but in the absence of other adverse clinical conditions, CHCs can be used until menopause 1, 2

The American College of Obstetricians and Gynecologists recommends monophasic pills containing 30-35 μg ethinyl estradiol with levonorgestrel or norgestimate as the preferred initial choice for women over 40 4
Second-generation progestins have lower thrombotic risk compared to third and fourth-generation progestins, according to the American Heart Association 4
Pills containing ≥35 μg ethinyl estradiol show statistically higher odds ratios for venous thromboembolism than lower doses, as reported by the American College of Cardiology 4

The American College of Cardiology recommends excluding absolute contraindications, including uncontrolled hypertension 5, 4
The American College of Cardiology also recommends excluding history of venous thromboembolism or pulmonary embolism 5, 6
The American Heart Association recommends excluding thrombophilia or prior thrombotic events 5
The American College of Cardiology recommends excluding migraines with aura or focal neurologic symptoms 5, 4

The American College of Cardiology reports that the incidence of venous thromboembolism is higher among oral contraceptive users aged ≥45 years compared to younger users 7, 8
The American Heart Association reports that the relative risk for myocardial infarction is higher among all oral contraceptive users than nonusers 7, 8

The American College of Obstetricians and Gynecologists recommends considering the levonorgestrel-releasing intrauterine device (LNG-IUD) instead of oral contraceptives if any cardiovascular risk factors are present 6
The LNG-IUD achieves pregnancy rates <1% per year and has no systemic cardiovascular effects, according to the American College of Obstetricians and Gynecologists 6, 9

The American College of Cardiology recommends checking blood pressure at least every 6 months for women using any hormonal contraceptive method 9
The American Heart Association recommends prescribing up to 1 year of COCs at a time to reduce barriers to access 4

The American College of Obstetricians and Gynecologists reports that combined oral contraceptives offer important health benefits for perimenopausal women, including decreased menstrual cramping and blood loss 4
The American College of Dermatology reports that combined oral contraceptives can improve acne through anti-androgenic properties 4
The American College of Obstetricians and Gynecologists reports that long-term use (>3 years) of combined oral contraceptives provides significant protection against endometrial and ovarian cancers 4