Contraception for females aged 40 to 49 years

Although any form of contraception can potentially be used in females aged 40 years or older, there are some additional age-related considerations. These include an increased likelihood of comorbidities, which may limit choices, and of conditions that may benefit from the noncontraceptive effects of hormonal contraceptives.

The 52 mg levonorgestrel-releasing IUD can be useful to manage heavy menstrual bleeding in perimenopausal individuals.

Combined hormonal contraception can be useful to manage heavy menstrual bleeding and menopausal symptoms, and to prevent loss of bone mineral density. The risk of cardiovascular disease and venous thromboembolism (VTE) increases with age, which may limit their use; see Contraception and venous thromboembolism.

Although depot medroxyprogesterone injection can be used (UKMEC 2) in individuals aged 45 to 49 years, it is generally not started in this age group. It is not recommended for individuals older than 45 years who have cardiovascular risk factors because it has an adverse effect on lipids. It is also associated with a loss of bone mineral density, which may not be regained before the drop in bone mineral density associated with menopause. For individuals older than 45 years continuing to use depot medroxyprogesterone, assess for other osteoporosis risk factors on an annual basis; a dual energy X-ray absorptiometry (DXA) scan can be considered on a case-by-case basis.