Q:
I am 47 years old and take oral contraceptives. My gynecologist says I can take them until age 50, but then I should stop so I can see where I am with menopause. I do not smoke and am in good health. Is it safe to keep taking oral contraceptives?
A:
Good for you for taking steps to prevent an unwanted pregnancy! I see too many women your age who think they're "too old" to get pregnant and just give up on birth control. But until you have gone 12 consecutive months without a period (the true definition of menopause), you could still become pregnant.
There's no age limit on any contraceptive option. Having said that, however, it's clear that some options are more appropriate than others based on a woman's individual circumstances and health profile.
For instance, you don't mention if you're married, in a monogamous relationship or dating, or how sexually active you are. All are issues you should discuss with your health care professional when determining contraceptive options. For instance, if you're having sex infrequently, you might want to consider a barrier method, such as a condom or diaphragm.
The most common birth control method used by perimenopausal women is sterilization, either tubal ligation, i.e., "having your tubes tied," or hysterectomy. Either is a pretty drastic option, however, since both involve surgery. Plus, research shows that other options can be just as effective when used appropriately.
If you're experiencing the heavy menstrual bleeding common to perimenopausal women, talk to your health care provider about the levonorgestrel IUD, which not only provides effective birth control, but may also help with the heavy bleeding. And, of course, another good option is the one you're already using—oral contraceptives. The combination estrogen-progesterone pill Natazia is the first birth control pill specifically approved by the FDA to treat heavy menstrual bleeding not caused by a condition of the uterus.
Decades ago — in the 1970s—women over 35 were told to stop taking oral contraceptives because of the potential risk of heart disease. Since then, however, we've learned that risk exists primarily for women who smoke, making birth control pills a good option for nonsmoking premenopausal women of any age. Plus, given the drop in the amount of estrogen used in oral contraceptives in recent years, the risks of other health conditions, including blood clots, stroke and heart disease, have also dropped.
In fact, long-term use of birth control pills has numerous health benefits, including reducing the risk of ovarian cancer, probably by preventing ovulation. Studies also suggest that birth control pills reduce the risk of endometrial cancer, colorectal cancer, pelvic inflammatory disease, fibroids and even endometriosis, as well as helping alleviate some of the heavy bleeding related to fibroids and endometriosis.
One of the main reasons perimenopausal women choose oral contraceptives as their contraception of choice is to help reduce the heavy bleeding and irregular periods often a part of this time of life. There's also some evidence they can help maintain bone density and reduce the risk of osteoporosis, as well as reduce the incidence of hot flashes, both of which concern perimenopausal women. An added bonus—they can help clear up middle-aged acne.
So, to summarize, it's fine to continue taking birth control pills up to age 50 or even 51 (keep in mind that the average age of menopause in this country is 51) as long as you don't have any risk factors for heart disease or other potential complications, including smoking, obesity, diabetes, high cholesterol, high blood sugar or migraines.
One reason your doctor suggested you stop taking birth control pills when you turn 50 is so you'll know if you've reached menopause. If you continue taking them as directed—with a week's break between active pills—you'll continue to menstruate and won't know.
Although the decision is between you and your doctor, you may want to consider at least taking a break for a few months and using a non-hormonal contraception to see if your periods continue, or if you have reached menopause and no longer need contraception.
