Page 2 2012 Vol 2
Contraception across your lifespan
Contraception needs change as women age. Knowing your options can help you make the right choices.
The average woman can potentially become pregnant for over 38 years of her life – from the time she gets her period until menopause. Throughout this time it’s important for women to use the right type of contraception to avoid unwanted pregnancy and sexually transmitted infections (STIs).
“During the earlier stages of their reproductive cycle, younger women need effective contraception as their fertility – and risk of unwanted pregnancy – is at its peak,” says Dr Kathy McNamee, Senior Medical Officer, Family Planning Victoria.
Best choices under 40
The implant (Implanon)
For younger women, Dr McNamee recommends the implant, a soft rod-shaped implant made from the hormone progestogen. Inserted under the skin on the inner side of the upper arm, it prevents the release of an egg each month and makes fluid at the opening of the womb thicker and harder for sperm to enter.
It is more than 99.9% effective.
Implanon lasts for three years and in about 25% of cases, women have no periods. Once removed, fertility quickly returns.
“The implant is cheap and effective and once it’s in there’s nothing much you can do to stop it from working, although some medications may interfere with the implant,” says Dr McNamee.
The main potential drawback is a woman can’t predict the bleeding pattern she may get. Some women experience regular spotting; sore breasts, weight gain, headaches, bloating, mood swings and skin changes are also possible side effects. However, if it doesn’t suit you it can easily be removed
The combined pill and the mini pill are 99.7% effective when used correctly. When mistakes happen (eg taken late, not renewing a script, delaying going to the chemist to fill that script) effectiveness drops to 91%.
The combined pill is made from oestrogen and progestogen, and each pack contains a mixture of hormone pills and sugar pills. The mini pill contains progestogen alone, with no sugar pills. The combined pill stops an egg being released each month and the mini pill thickens the fluid at the womb entrance. The mini pill usually works better in older women and is a better option for women who suffer migraines, smoke, have high blood pressure or are breastfeeding.
The combined pill can make periods lighter, shorter and less painful. It reduces the chance of ovarian or uterine cancers, but may not be recommended for women who are overweight, have high blood pressure or heart or liver conditions, smoke, and are taking certain other medications.
Younger women are at higher risk of STIs, so contraception should be backed up with condoms to reduce the risk of common infections such as Chlamydia which, left untreated, can reduce fertility. “Most STIs don’t have symptoms so having a yearly screen for infections such as Chlamydia is important,” says Dr McNamee. “You can check with a simple urine test or take a swab from your vagina and it’s usually treatable with a single dose of antibiotics.”
What’s new in contraception?
Best choices: 40 and beyond
Family Planning Victoria says it’s safe to stop using contraception after one year of no periods if you are over 50, or after two years without a period if you are younger than 50. Until then, while fertility declines swiftly, pregnancy is still a possibility.
In their 40s, women don’t have a high conception rate, but unplanned pregnancies do exist in this group, together with a high rate of accessing abortions if they conceive. Increasing age, higher blood pressure and weight gain are all factors that should be considered when determining the appropriate method of contraception.
“Your blood pressure might be up and you may be unaware you have developed diabetes. If you have risk factors we’d look at methods that don’t contain oestrogen, like the implant, the mini pill, or an IUD,” says Dr McNamee.
There are two types of intrauterine devices (IUDs) in Australia – copper and hormonal.
An IUD is a small T-shaped piece of plastic with a nylon string at the end. It is placed inside the womb by your GP or gynaecologist and lasts for years. It stops sperm reaching an egg and prevents an egg from implanting in the womb. IUDs are more than 99% effective in stopping pregnancy.
“The hormonal IUDs are particularly good to reduce heavy bleeding. As women get older they can have heavier bleeds. With the hormonal IUD, most women experience lighter, regular periods and about 50% have no period at all,” explains Dr McNamee.
“Contraception can slip down the list of priorities for older women, so an IUD can be good – just fit and forget.”
Condoms are still important as an effective barrier against STIs – particularly if a relationship is ending and women are entering a new sexual relationship.
“An older woman’s risk of STI is not as high as for a younger woman but the risks are still there,” says Dr McNamee.
“If you are in a stable relationship it’s a personal decision and some women may decide not to use condoms. Others may find it difficult to discuss condoms because they were raised in a generation when it might have been considered upfront for women to discuss it. But for any woman in a new sexual relationship, it’s important she feels confident to raise the issue.”
What are the key health risks linked to contraceptives? Oestrogen-containing contraceptives, eg the pill and vaginal ring, may increase the risk of blood clots, heart attack and stroke in some women. However, the risk is small and increases with age. Discuss your safest and most effective choice with your GP.
Do contraceptives cause cancer?
The link to cancer is complicated and controversial, says Dr McNamee. “If you’ve had breast cancer that has been active within the past five years you shouldn’t take hormonal contraception.” However, there is a decreased risk of cancer of the ovaries and endometrium. Your GP will advise the safest contraceptive options based on your medical history and health.
Will contraception make me infertile?
There’s no evidence that contraception reduces fertility.
The Depo-Provera injection can delay the return of periods for some time when you stop using it but it has no long-term effect.
Is it true that the pill causes weight gain?
There is no good evidence that the pill increases weight.
Family Planning Victoria has fact sheets about methods of contraception.
Go to www.fpv.org.au and click on sexual health info.
Content Updated September 2012