Contraception in women over forty

Nonhormonal contraceptives include the condom that is safe and frequently used lately because of its ability to help in the prevention of sexually transmitted diseases. There is often psychological resistance to the use of diaphragm in the over 40 age group. The rhythm method is not reliable especially in irregular menstrual cycles and its lack of reliability can cause anxiety. In the US 16% of women over 40 use spermicides. The IUD is recommended to women over 40 because of 1-time insertion no requirement of care efficacy and the risk of pelvic inflammatory disease is modest at this age. IUDs with progesterone are particularly effective and seem to reduce the risk of inflammatory disease by making the cervical mucus more viscous. Surgical sterilization is not recommended at this age. Women over 40 who are not obese do not smoke and do not have a family history of cardiovascular disease have no contraindications to using modern oral contraceptives (OCs). On the other hand family history of diabetes and hyperlipidemia has to be assessed on an individual basis. Low dose contraceptives can have outright beneficial effects in vascular pathology by improving the hemostatic profile. Recently animal research has suggested the possibility of a protective effect of OCs on the cardiovascular system. OCs also protect against osteoporosis. Although the debate is still unresolved at the moment there is no proof whatsoever that OCs increase the risk of breast cancer in women over 40. The evaluation of patients for OC use has to include a diabetic history of mother or father familial cardiovascular disease overweight by more than 20% smoking more than 10 cigarettes a day and hypertension. If findings are negative there is no appreciable risk for the patients. Mammography every 2 years for those with familial precedents laboratory tests (lipid profile coagulation and hepatic function) and semiannual checkups are also be recommended.