Contraception over 40

By Dr Penny Caldicott

Contraception can be such a drag! Finding the ultimate method of birth control—one that’s convenient, safe and effective for everyone—is high on my GP wish list. Take one of my patients, Liz, a 43-year-old mother of three. She’s struggled for years to find a method that works for her. After suffering migraines on the Pill, she tried an IUD (intra-uterine device), which gave her painful, heavy periods. So she tried condoms—which gave her a rash (and her husband hated them!). As a result, she has resorted to the rhythm method—and occasionally, the morning-after pill. As Liz has discovered, it’s a good idea to consider all methods. Here’s an overview:

The Pill

This combination of synthetic oestrogen and progesterone, taken daily, prevents ovulation. Some women experience short-term side effects such as migraines,high blood pressure, weight gain and depression.

Hormonal Implant

Called Implanon, this progestogen-only device works well for women who can’t tolerate synth
etic oestrogens. Your doctor inserts it just under the skin in your upper arm, and it lasts for three years.

Vaginal Ring

This device contains oestrogen and progesterone, which slowly release as a combined daily dose. It’s easy to use and less likely than the Pill to cause side effects.

IUD

This small plastic progesterone-impregnated device lasts for five years and sits in the uterus, preventing the egg and sperm from coming into contact. IUDs can be a better option if you experience side effects from the Pill or if you’re looking for a longer-term solution.

Condom

Condoms are cheap, simple and non-medical. But many couples find that they reduce sexual pleasure, and some women have a rashlike reaction to the latex in male condoms.

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Diaphragm

This soft rubber cup fits over the cervix, preventing sperm from entering. Although it’s easy-to-use and side-effect-free, it has a significant failure rate, often due to improper use.

Rhythm Method

This calendar-based technique involves learning about your menstrual cycle. It can be an effective method, but only if your cycle is regular, and if you’re prepared to keep tabs on it.

Emergency Contraceptive Pill

You can take this ‘morning-after pill’ up to 72 hours after sex to disrupt fertilisation. There is no serious risk, and it’s reasonably effective.

Sterilisation

Tubal ligation for women and vasectomy for men are both options for couples who have finished building their families. These procedures are effective, but consider them carefully, as they aren’t always reversible.