Contraceptive considerations for older women.

CONTRACEPTIVE CONSIDERATIONS FOR OLDER WOMEN

METHOD                             ADVANTAGES

LESS EFFECTIVE *

Abstinence (periodic)              * Does not mask menopause

Condoms (male or female)           * Only methods that protect against
                                     HIV/STIs
                                   * Do not mask menopause

Diaphragms, caps                   * Do not mask menopause

Spermicides                        * Do not mask menopause

EFFECTIVE *

Combined oral contraceptive        * Strongly protect against ovarian
pills (COCs)                         and endometrial cancer
                                   * Prevent bone loss
                                   * Normalize menstrual bleeding
                                   * Control menopausal symptoms

Progestin-only pills (POPs)        * Can be safely used when estrogen
                                     is contraindicated

Emergency contraceptive pills      * No medical contraindications for
(ECPs): COCs or POPs                 use by women at risk of
                                     cardiovascular disease

MORE EFFECTIVE *

Combined injectable                * Estrogens in CICs may be less
contraceptives (CICs)                potent than those in COCs,
                                     possibly causing fewer side
                                     effects

DMPA: progestin-only injectable    * Can be safely used when estrogen
                                     is contraindicated
                                   * Protects against uterine fibroids
                                   * May protect against endometrial
                                     cancer

Subdermal implants                 * Can be safely used when estrogen
                                     is contraindicated
                                   * Effective for 5 to 7 years

Intrauterine device (IUD):         * Effective for at least 12 years
Copper T 380A                      * Does not mask menopause
                                   * May protect against endometrial
                                     cancer

Levonorgestrel intrauterine        * Effective for at least 7 years
system (LNg-IUS)                   * Reduces menstrual bleeding
                                   * Complements hormone replacement
                                     therapy

Sterilization (male or female)     * May protect against ovarian
                                     cancer
                                   * Does not mask menopause

METHOD                             DISADVANTAGES

LESS EFFECTIVE *

Abstinence (periodic)              * Determining fertile days may be
                                     difficult if menses are irregular
                                   * No HIV/STI protection

Condoms (male or female)           * Must be used correctly with each
                                     act of intercourse

Diaphragms, caps                   * Devices may be difficult to fit
                                     in older women
                                   * Protection against HIV/STIs
                                     unknown

Spermicides                        * No HIV/STIs unknown

EFFECTIVE *

Combined oral contraceptive        * Not appropriate for women at risk
pills (COCs)                         of cardiovascular disease
                                   * Mask menopause
                                   * No HIV/STI protection

Progestin-only pills (POPs)        * Regimen requires stricter
                                     compliance than for COCs
                                   * NO HIV/STI protection

Emergency contraceptive pills      * Not meant for repeated use
(ECPs): COCs or POPs               * No HIV/STI protection

MORE EFFECTIVE *

Combined injectable                * Not appropriate for women at risk
contraceptives (CICs)                of cardiovascular disease
                                   * No HIV/STI protection

DMPA: progestin-only injectable    * May make bleeding patterns
                                     unpredictable
                                   * No HIV/STI protection

Subdermal implants                 * May make bleeding patterns
                                     unpredictable
                                   * No HIV/STI protection

Intrauterine device (IUD):         * May add to menstrual bleeding
Copper T 380A                        problems
                                   * Insertion may be more difficult
                                     in older women
                                   * No HIV/STI protection

Levonorgestrel intrauterine        * Insertion may be more difficult
system (LNg-IUS)                     in older women
                                   * No HIV/STI protection

Sterilization (male or female)     * Irreversible
                                   * No HIV/STI protection

* Effectiveness is defined here as: "less effective" for most users
(becoming "effective" when used consistently and correctly),
"effective" for most users (becoming "more effective" when used
consistently and correctly), and "more effective" for all users.
Definition of effectiveness adapted from Trussell J. Contraceptive
efficacy. In Hatcher RA, Trussell J, Stewart F, et al., eds.
Contraceptive Technology, Seventeenth Revised Edition. New York:
Ardent Media, 1998.