Contraception at age 35 years and older

Contraceptive methods and use by women aged 35 and over: A qualitative study of perspectives

BACKGROUND

More than 30% of the pregnancies in women aged 35 and over are unintended. This paper compares perceptions about contraceptive methods and use among women with and without an unintended pregnancy after turning age 35.

METHODS

Semi-structured, in-depth interviews were conducted with 17 women. They were all 35 to 49 years old, regularly menstruating, sexually active, not sterilized, not desiring a pregnancy in the near future, and at least 3 months postpartum. We purposely sampled for women who had had at least one unintended pregnancy after age 35 (n = 9) and women who did not (n = 8). We assessed partnership, views of pregnancy and motherhood, desired lifestyle, perceived advantages and disadvantages of using and obtaining currently available well-known reversible contraceptives in the U.S. ''We also assessed contraceptive methods used at any time during their reproductive years, including current method use and, if appropriate, circumstances surrounding an unintended pregnancy after age 35.'' Each interview was taped and transcribed verbatim. Data were analyzed using Grounded Theory. Analysis focused on partnership, views of pregnancy, motherhood, desired lifestyle and perceived advantages and disadvantages of various reversible contraceptive methods.

RESULTS

The women without an unintended pregnancy after age 35 were more likely to (1) use contraceptive methods that helped treat a medical condition, (2) consider pregnancy as dangerous, or (3) express concerns about the responsibilities of motherhood. The women who experienced an unintended pregnancy after age 35 were more likely to (1) report unstable partnerships, (2) perceive themselves at lower risk of pregnancy, or (3) report past experiences with unwanted contraceptive side effects. There was a greater likelihood a woman would choose a contraceptive method if it was perceived as easy to use, accessible, affordable and had minimal side effects.

CONCLUSIONS

Women's perspective on contraceptive use after age 35 varies. Public health messages and health providers' care can help women in this age group by reviewing their fertility risks, as well as all contraceptive methods and their associated side effects. The impact of such interventions on unintended pregnancy rates in this age group should be tested in other areas of evidence-based medicine.

Implanon use in Thai women above the age of 35 years

A prospective study of Implanon implant use in women older than 35 was conducted in Bangkok, Thailand. The purposes of this study were to evaluate the menstrual pattern and side effects of Implanon in 51 women followed for 6 months. Their mean age was 39.7 years. Most acceptors had completed primary school. No accidental pregnancies occurred in 6 months of use. The most common menstrual pattern in these acceptors was irregular bleeding followed by amenorrhea. The major side effect was irregular bleeding. There was no significant change in body weight, body mass index and diastolic blood pressure during the 6-month follow-up period, but systolic blood pressure declined. Implanon implant use is a safe and effective contraceptive method and should become another choice for contraception in women aged above 35 years who have contraindications for oral contraceptive use.

Change in mammographic breast density associated with the use of Depo-Provera

We report two cases in which routine mammograms showed a significant increase in breast density compared to previous studies. Review of patient histories revealed that both women had been receiving contraceptive injections of Depo-Provera at the time of their earlier mammograms. Breast density increased after Depo-Provera was discontinued. We postulate that Depo-Provera has a suppressive effect on breast density. Alterations in breast density may have implications regarding breast cancer risk. Etiologies of generalized change in breast density are reviewed.

Efficacy and side effects of Norplant use in Thai women above the age of 35 years

A prospective study of Norplant implant use in women aged above 35 years was conducted in Bangkok, Thailand. The purposes of this study were to evaluate the efficacy, menstrual patterns, and side effects of Norplant use in these women. A total of 100 women were recruited in a 1-year clinical study. Their mean age was 39.7 years. Most acceptors had completed secondary school. No accidental pregnancy occurred throughout the 1 year of use in this study. The most common menstrual pattern in these acceptors was amenorrhea followed by irregular bleeding. The major side effect was irregular bleeding. There was no significant change in systolic and diastolic blood pressure during the 1 year follow-up period. Thus, Norplant implant use in older women is a safe and effective contraceptive method. This should become another choice for contraception in women aged above 35 years who have contraindications for oral contraceptive use.

DMPA use above the age of 35 in Thai women

A prospective study of depot-medroxyprogesterone acetate (DMPA) use in women aged above 35 years was conducted in Bangkok, Thailand. The objectives of the study were to evaluate efficacy, continuation rate, and side effects of DMPA use in these women. A total of 60 women were enrolled in a one-year clinical trial. Their mean age was 38 years. Most of them had completed primary school. No accidental pregnancies occurred throughout the 1-year use in this study. The continuation rate was 20%. Irregular bleeding was the major cause of termination. The major side effect was also irregular bleeding. Nevertheless, DMPA in older women is a safe and effective contraceptive. DMPA is a contraceptive akterbatuve fir women aged above 35 with contraindications to combination oral contraceptives.