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Fitzgerald Health Education Associates, Inc., January 2015 fhea.com
Contraceptive Pearls
Contraception After 40
Many women stop using contraception after age 40
because they believe they can't get pregnant. Howev-
er, infertility rates for wom en over 40 are lower than
many might expect: about 17% at age 40, 55% at age
45, and 95% at age 50.
The Department of Health and Human Services
reports an increase in fertility over the past two
decades for women 40 to 49 years old. In the United
States, 75% of pregnancies in this age-group are
unplanned, and the abortion rate for this age-group
is increasing. Gestational diabetes, preeclampsia,
hypertension, and birth defects are more likely to
complicate pregnancy in women over age 40.
Women may safely stop using contraception after
menopause. This means 12 months without a period
for women over age 50 and 24 months without a
period for women under age 50. Clinicians should be
aware of older women's risk of pregnancy and talk
to their patients about contraception until
menopause.
Sources
Faculty of Sexual & Reproductive Healthcare. Royal College of
Obstetricians and Gynaecologists. Clinical Guidance. July 2010.
London, England.
Crosignani PG. Female contraception over 40. Human Reprod
Update. 2009;15:599-612.
Baldwin MK, Jensen JT. Contraception during the perimenopause.
Mauritas. 2013;76:235-242.
Long ME, Faubion SS, MacLaughlin KL, Pruthi S, Casey PM. Con-
traception and hormonal management in the perimenopause. J
Women's Health. 2014:April 28. [Epub ahead of print]
The Low-Dose Progestin
IUD
Skyla, the levonorgestrel-releasing 13.5-mg intrauter-
ine device (LNG IUD), is the newest IUD approved by
the FDA. This progestin-releasing IUD is 99% effective
at preventing pregnancy for up to 3 years.
Skyla lasts for a maximum of 3 years (compared
with 7 years for the Mirena LNG-IUD 52 mg). This
shorter length of time
decreases Skyla's cost-
effectiveness
compared with Mirena,
but Skyla's smaller size (1.1 x 1.2 inches)
compared with Mirena (1.3 square inches)
may result in a slightly easier and less painful
insertion. Skyla can be used whether or not a
woman has had a child.
Skyla is less likely than Mirena to cause
amenorrhea. Additionally, it has not been shown
to be an effective treatment for heavy menstrual
bleeding. Women who want lighter periods but feel
wary of having no period at all may want to choose
the lower-dose progestin IUD. Those who want to
avoid hormones entirely can choose the copper IUD,
which generally causes heavier periods with more
cramps. Thus, for women who prefer an IUD that
doesn't stop their monthly period but doesn't make
it heavier, Skyla may be the best choice.
Providers should be cautioned that in earlier
studies when a patient did become pregnant with the
low-dose progestin IUD (which is rare), 50% of the
time it was an ectopic pregnancy, so the location of
the pregnancy should be determined urgently.
•
Helpful Resource
Reproductive Health Access Project. IUD Fact
Sheet. Accessed at
http://www.reproductive
access.org/resource/iud-facts/
Sources
Wu JP, Pickel S. Extended use of the intrauterine device: a litera-
ture review and recommendations for clinical practice. Contra-
ception. 2014;89:495-503.
Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized,
phase II study describing the efficacy, bleeding profile, and safety
of two low-dose levonor gestrel-releasing intrauterine contracep-
tive systems and Mirena. Fertil Steril. 2012;97:616-622.
A new low-dose levonorgestrel-releasing IUD (Skyla). The Med-
ical Letter Online. 2013;1412:21-23.
Reprinted with permission from Reproductive Access .
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