Contraception at age 35 years and older

About 85% of all births in the US occur to women under 35 years of age. According to the US National Survey of Family Growth, women aged 35-39 years expect to have an additional 0.3 births while those 40-44 years anticipate only 0.1 additional births. Thus, there is a need to protect women age 35 years and over from unwanted pregnancy until menopause occurs. Sterilization continues to be the most common choice for married women older than 30 years. The IUD may be an excellent alternative to sterilization. Oral contraceptive (OC) use declines in women over 35 years because of concerns about increased cardiovascular risk. However, new studies have indicated myocardial risk in older women is mainly limited to women with other cardiovascular risk factors such as smoking, hypertension, and diabetes. Moreover, the OC-related benefits of protection against ovarian and endometrial cancer, reduced menstrual blood loss, and increased bone density are especially important to women over 35 years. Since it is impossible to diagnose menopause within the pill-free week, OC users should stop the pill for a month at around 50 years of age to allow accurate follicle-stimulating hormone measurement.