Why contraceptives are still essential after 40 until menopause is confirmed

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Contraception is often considered a priority during the early reproductive years, but many women overlook its importance after the age of 40. Fertility decreases with age, but pregnancy is still possible, and unplanned pregnancies can carry significant health risks for both mother and child.

On World Contraception Day, Dr. Asha Dalal, Director, Obstetrics and Gynaecology, Sir H.N. Reliance Foundation Hospital, Mumbai, highlights why women should continue using contraception until they are certain they have reached menopause.

Women can get pregnant even in their 40s

While the increase in age is linked to decrease in fertility among women, the chances of pregnancy do not vanish entirely.

"As women age, their fertility naturally declines due to the depletion of viable eggs and changes in hormonal balance. By the time a woman reaches her 40s, the chances of conceiving decrease significantly. However, the likelihood of pregnancy, though reduced, does not entirely vanish. Some women continue to ovulate until menopause, making pregnancy a possibility even in their late 40s," clarifies Dr. Dalal.

"The period leading up to menopause, known as perimenopause, is marked by irregular menstrual cycles and fluctuations in hormone levels, but ovulation may still occur sporadically. Since ovulation can be unpredictable, women may unknowingly be at risk of pregnancy, even if their periods have become irregular or less frequent," she adds.

Health risks of pregnancy after 40

While there have been several instances of women successfully navigating pregnancy after the age of 40, there are many health risks associated with it.

Dr. Dalal states the following risks:

• Women over 40 are more likely to experience complications such as gestational diabetes, preeclampsia and hypertension.
• There is also a higher risk of chromosomal abnormalities in the baby, such as Down Syndrome.
• The rates of miscarriage and still birth are higher in older women, as are the chances of requiring a cesarean section due to complications during delivery.

Additionally, she states, "Unplanned pregnancies at this age can be emotionally, physically and financially taxing, especially when health concerns are at the forefront."

When to stop contraception?

Given the health risks associated with unplanned pregnancies, contraception methods should be used until menopause is confirmed. However, determining this can prove to be challenging.

"Menopause is confirmed when a woman has gone 12 consecutive months without a menstrual period. However, during perimenopause, menstrual cycles can be erratic, and women may go several months without a period, only to menstruate again. This unpredictability makes it difficult to determine when ovulation has truly ceased," explains Dr. Dalal.

"One year without a period or in some cases, hormone tests may be used to assess whether a woman has entered menopause. These tests are not always definitive due to hormonal fluctuations during perimenopause," she adds.

Also Read: ‘I couldn't even talk to my friends about it': Why women in their 40s are now talking about Perimenopause

Contraceptive options for women over 40

There are various contraceptive options that can be considered, keeping the age factor in mind.

"If you are not having sex often, you may not want a daily hormonal pill or long-term contraceptive," says Dr. Dalal.

She reveals the following options:

• Non-hormonal methods like condoms, copper IUDs and sterilisation are viable choices for those concerned about hormone use.
• Hormonal methods, such as birth control pills, hormone-releasing IUDs or implants can also be considered, though they may not be suitable for women with certain health conditions, like a history of blood clots or breast cancer.

Additionally, she mentions, "For some women, hormone-based contraception offers the additional benefit of managing perimenopausal symptoms, such as hot flashes, heavy periods and mood swings. However, the choice of contraception should always be personalised based on a woman's overall health, lifestyle and reproductive goals."

Consulting a healthcare provider can help women choose the safest and most appropriate contraceptive method. Additionally, contraception should be a shared responsibility among men and women.

Disclaimer: This information does not replace professional medical advice. Consult a qualified expert for personalised guidance.