What contraceptives to choose for women after 40 years
It is known that after 40 years due to hormonal changes the reproductive function of women begins to gradually fade. Despite the fact that the probability of pregnancy at this age is significantly reduced, it is still quite possible, and its interruption in case of undesirability is fraught with serious consequences and hormonal disturbances. In this regard, the problem of reliable contraception does not lose its relevance. For women after 40 years, the choice of contraceptives is complicated by chronic diseases and an increased risk of side effects.
- Features of contraception after 40
- Birth control pills
- Intrauterine spirals
- Hormonal contraceptives for long-acting
- Surgical methods
Features of contraception after 40
After 40 years in the female body , the period of premenopause comes - the beginning of the natural physiological decline of the reproductive function. The ovaries produce less sex hormones, the number of ovulations decreases and the frequency of menstruation. Nevertheless, according to statistics, almost 80% of women between the ages of 40 and 43 are capable of conceiving and bearing a child.
Changes in the hormonal background in this age period lead to the development of osteoporosis, weight gain, hair loss, withering of the skin, increased risk of cardiovascular diseases, slowing of metabolism, imbalance of vaginal microflora and other abnormalities.
The following methods of contraception are suitable for women of age category after 40 years:
- birth control pills;
- intrauterine spirals;
- hormonal rings, patches, implants;
- surgical sterilization.
Given that the body is no longer so young, there may be health problems in which certain contraceptives are contraindicated. The choice of a specific method of protection for a woman after 40 years of age should be carried out together with the gynecologist who observes her. The doctor based on the study of anamnesis and thorough examination will select the best option taking into account all the potential risks. The chosen method should be effective, comfortable for a woman in view of her lifestyle, the nature of sexual relations and not pose a threat to health.
Birth control pills
Contraceptive pills containing synthetic analogues of female sex hormones are quite popular among many women with a contraceptive. The mechanism of their action is associated with oppression of ovulation, increased viscosity of cervical mucus and changes in the structure of the endometrium . On the shelves of pharmacies today you can find many such drugs that differ in dosage and composition of hormones. Of these, relatively monophasic combined oral (COC) and gestagenic contraceptives (mini-pili) are considered relatively safe for women over 40 years of age.
The benefits of hormonal drugs include that, in addition to contraceptive, they have other indications:
- have a positive effect on the condition of the skin, hair, nails;
- are used for the prevention and treatment of cysts, endometriosis, endometrial polyps , adenomyosis , fibroids and other pathological formations, including oncology, in the uterus and mammary glands;
- reduce the likelihood of inflammation in the organs of the female reproductive system;
- improve the mineral metabolism, promote the normalization of bone density and prevent osteoporosis;
- normalize the menstrual cycle;
- eliminate unpleasant symptoms of PMS and premenopause.
They are shown to women over 40, who have a regular sex life with one partner. Contraceptive pills are considered the most reliable way to prevent unwanted pregnancies, their effectiveness is 99% for COCs and 95% for mini-pills. However, when applying them, it is important to follow the instructions exactly. Depending on the specific drug, the tablets should be consumed daily or for 21 days with a break of 7 days at the same time. Skipping or late reception significantly reduces the contraceptive effect.
Monophasic COCs are preparations containing synthetic analogues of estrogen (ethinylestradiol) and progestagen (gestodene, dienogest, desogestrel, norgestrel, norethisterone, dydrogesterone and others) as active components. Each tablet has the same unchanged dosage of estrogenic and progestational components.
The main contra-indications for the use of monophasic COCs are:
- thrombosis of the veins of the lower limbs;
- varicosity ;
- increased coagulability of blood;
- weak immunity ;
- diseases of the cardiovascular system;
- severe liver and kidney pathologies;
- metabolic disorders;
- disease of the endocrine system;
- malignant formations in the organs of the genitourinary system;
- suffered heart attacks and strokes;
For women over 40 years of age, monophasic COCs are recommended low-dose with a dosage of ethinylestradiol 30 μg (rigevidone, jarina, midian, regulon, lindinet 30, silhouette) and microdosed with a dosage of ethinylestradiol 20 μg (novinet, lindinet 20, mercilone, dzhes).
The gestagenic contraceptives contain only one hormone - progestogen in the minimal dosages. They are considered less reliable in terms of contraception compared to COCs, since they do not suppress ovulation, but because of the lack of estrogens have a milder effect on the body, have fewer contraindications and side effects. Their action is based on a change in the properties of the mucus of the cervix, it becomes more viscous and thick and creates an obstacle to sperm on the way to the egg. Also, these drugs affect the internal mucosa of the uterus and make it unsuitable for attaching a fertilized egg.
To gestagenic drugs include charosette, continuum, exluetooth, microlus, micronor and others. Unlike COCs, they are allowed to be used in the following situations:
- the period of breastfeeding;
- presence of pathologies of the cardiovascular system;
- increased coagulability of blood;
These contraceptives can be used after 40 years by women, for whom the use of COC because of their health is unsafe and fraught with serious complications.
Intrauterine spirals (IUDs) are considered one of the most effective contraceptives after birth control pills. They can be ordinary (with copper or silver) and hormonal. Establishes such a device in the uterus of an obstetrician-gynecologist for a period of 5 years or more, depending on the type of spiral. Within six months after setting the spiral, there are sometimes unpleasant or painful sensations in the lower abdomen and menstrual irregularities.
Women after 40 should preferably use hormonal IUDs, since the usual often provoke an additional growth of the endometrium and the formation of pathological formations in it. They are characterized by a higher degree of protection from unwanted pregnancy and virtually eliminate the possibility of ectopic pregnancy. Unlike conventional spirals, hormonal IUDs with progestogens, on the contrary, reduce the risks of hyperplastic endometrial processes , which often occur in women older than 40 years.
Condoms are a rather popular contraceptive that can be used by couples of any age, including those over 40. Their significant advantage over other contraceptives is the absence of contraindications and negative effects on the body, as well as reliable protection against sexually transmitted infections.
Condoms should be used as a contraceptive for women who have many sexual partners and have an irregular sexual life. Their disadvantages include possible discomfort during or after sexual intercourse, a decrease in sensitivity and acuity of sensations in partners. Some have allergic reactions (most often in the form of itching and burning in the vagina) on latex, lubricant or flavors used in the production of condoms.
The degree of protection of condoms from unwanted pregnancies is somewhat lower than that of intrauterine spirals and oral contraceptives. This is due primarily to the fact that they can form poorly visible cracks, especially when the size does not match, improper use, expiration or non-compliance with storage conditions. Through microcracks a small amount of spermatozoa can easily penetrate the vagina. In addition, they can tear and slip directly into the process of sexual intercourse, which greatly increases the chances of becoming pregnant.
Hormonal contraceptives for long-acting
In addition to hormonal tablets, there are long-acting hormonal contraceptives. To the permitted after 40, are:
- Vaginal hormonal ring (Nova Ring). It is a flexible elastic circle of hypoallergenic material, containing minimal doses of ethinyl estradiol and thisgastrel. After the introduction takes the form of a woman's body and does not cause her special discomfort. The effect of this contraceptive is maintained during one menstrual cycle.
- Transdermal patch (Evra) is a plaster in the form of a square containing the minimum concentrations of hormones of ethinyl estradiol and noregestromine. Glue on the skin in the buttocks, abdomen, outer side of the upper part of the shoulder or upper half of the trunk. Use it should be from the first day of menstruation for three weeks, then a break for 7 days and a new adhesive is stuck.
- Injectables (Depo-Provera) contain a hormone of a number of progestogens medroxyprogesterone, are administered to women intramuscularly and have a contraceptive effect for 3 months.
- Subcutaneous implants (Norplant) are silicone capsules with levonorgestrel. They are inserted under the skin in the inner side of the forearm in an amount of 6 pieces. Manipulation is performed under local anesthesia. Capsules are a depot from which small doses of the hormone are secreted daily and absorbed into the blood. The duration of the contraceptive effect after their administration is 5 years.
Despite the ease of use and the inability to take tablets daily, these drugs are quite expensive, some of them cause the same undesirable side effects as COCs.
After 40 years, one of the methods of contraception, which is sometimes offered to women, is surgical sterilization. It consists in bandaging, excising or laser coagulation of the fallopian tubes, which excludes the possibility of "meeting" the spermatozoon with the egg in the future. Before taking such a step, a woman should think very well, since in the overwhelming majority of cases a complete restoration of genital function is impossible, there is only an option to give birth to a child with the help of an expensive IVF procedure.
Sterilization is performed by the method of laparoscopy or cavitary operation during the re-caesarean section in case the couple no longer wants to have children. This method is recommended for women who have serious gynecological or systemic diseases in which a potential pregnancy presents significant risks to their health and even life. Regardless of the reasons, sterilization is carried out only after signing a written consent.
Video: Review of existing contraceptives