Risks of Hormonal Contraception After Age 40

Unless you are trying to get pregnant, you will likely need some form of birth control in your 40s and 50s until you have fully transitioned to menopause. While the same birth control method you used in your 20s and 30s may work just as well beyond those decades, there are some real age-related concerns regarding the use of estrogen-containing birth control in some older women.

This doesn’t mean that you should abandon the pill the moment you turn 40 (particularly if you are sexually active), but rather that you work with your healthcare provider to consider the most appropriate birth control options as your body and sexual lifestyle start to change.

Pregnancy After 40

Many women in their 40s and 50s may stop using birth control prematurely at the first signs of perimenopause, mistakenly believing they are no longer fertile. Research shows that women over 40 are less likely to use birth control than any other age group.

However, until you have gone 12 consecutive months without periods or any bleeding (marking full menopause), you should use a reliable form of birth control to prevent pregnancy.

According to a 2016 study in the American Journal of Obstetrics and Gynecology, 77% of women between 44 and 50 are at risk of unplanned pregnancy.

While many women over 35 have healthy pregnancies, it’s important to note the increased risks such as preeclampsia, gestational diabetes, premature birth, and birth defects. These factors may influence the decision to continue using contraception until reaching menopause.

Benefits of Hormonal Contraceptives

For some women, continuing with their usual birth control method may be a good choice. It can even provide health benefits.

Previously, it was thought that women over 40 should only use non-hormonal methods like condoms, diaphragms, or tubal ligation. These views have evolved.

Research now suggests that the benefits of oral contraceptives often outweigh the risks, and combination birth control pills are safe for most healthy women over 40.

Beyond preventing pregnancy, oral contraceptives can:

Risks of Hormonal Contraceptives

While there generally are more pros than cons to the use of hormonal birth control—whether as a pill, patch, or intravaginal ring—it may not always be the best option for women over 40.

One of the major concerns is that ongoing exposure to estrogen may increase the risk of stroke and thrombosis (blood clots) in older women. This includes life-threatening deep vein thrombosis (DVT) and pulmonary embolism (PE).

Estrogen-containing birth control pills are also associated with a 20% increased risk of breast cancer, especially if taken for more than five years. High-dose estrogen and triphasic pills pose the greatest risk overall. While it is unclear if estrogen-containing patches or rings can increase the risk of breast cancer, most experts believe the risk is low.

Ethinyl estradiol (the type of estrogen used in birth control) can also be hard on the liver and cause injury to women with acute liver disease. The risk appears to be limited to the pill, which is metabolized by the liver, rather than patches or rings, which deliver estrogen directly to the bloodstream.

Health Considerations

As concerning as these risks may be, not every woman on oral contraceptives needs to change treatment the moment she turns 40. In most cases, an immediate change won’t be necessary.

As a general rule, you should discuss a change in oral contraceptives if you have an underlying health condition that places you at an increased risk of blood clots, liver injury, or certain cancers.

Some of these conditions are age-related and may not have been an issue when you were younger. Therefore, a form of birth control that may have been best for you in the past may not be so today.

Among the conditions and factors that contraindicate the use of ethinyl estradiol are:

Caution should also be used when prescribing estrogen-based oral contraceptives to women who are obese, as it can increase the risk of cardiovascular disease.

Lifestyle Considerations

Lifestyle also factors into the choice of birth control. After 40, your body will have changed, and there may be other, more appropriate options to consider. Habit alone cannot justify the routine, open-ended use of estrogen if, for example, you don’t have sex all that often.

To address these changes, many OB/GYNs will routinely wean their patients off estrogen-containing oral contraceptives after 40, moving them instead to the mini-pill or an intrauterine device (IUD). Vasectomy in a male partner could also be considered.