Thrills and pills: exploding the myths about contraception for over-40s

Older and wiser you may be, but you can still get caught out by an unexpected pregnancy

Getting pregnant young might have seemed like the worst thing that could happen, but an unexpected pregnancy when older fills many with equal dread. Whether you’ve decided your family is complete or you don’t want children at all, what is the best contraceptive for you as you age?

One myth is that it’s unhealthy for women over 40 to remain on the pill, says Rita Galimberti, assistant Master at the Coombe women’s hospital.

“Provided people are healthy, age itself is not a problem in taking the normal pill,” she says. “Age is only a contraindication if there are other factors – if the woman is obese . . . or [has] a cardiovascular problem.” In such cases, Dr Galimberti advises women to ask their GP about the progesterone-only pill.

Easing menopause

Using the pill at a certain age can also ease the symptoms of approaching menopause.

“The pill does become quite useful for that age group because it’s a time in their lives when they can start to have a little bit more trouble with their periods, which can become a bit irregular,” says Dr Galimberti.This can increase the risk of pregnancy for those using the natural contraceptive method, she warns, a method that becomes unreliable when periods are irregular.

Among those who have completed their families, intrauterine devices, also known as “the coil”, are popular.

“With a uterine device, you don’t have to worry about taking a tablet: it’s very reliable and safe,” she says.

Inserted by a specially trained GP or at a family planning clinic, the coil works in two ways: it helps prevent fertilisation by making it difficult for the sperm to get to the egg; then, if the egg is fertilised, the coil prevents implantation.

“So there is a post-fertilisation effect as well,” says Dr Galimberti. “That is important to make clear to women, in case they have any ethical concerns.”

How long the coil lasts depends on which one you choose. “A woman over 40 can leave the copper coil in forever, or until she goes through menopause and doesn’t need it any more.” Coils medicated with progesterone last for five years.

While the failure rate of the pill, at about 1 per cent, is low; that of the coil is lower still. “The pill fails because people make mistakes, so it’s not a method failure; it’s what we call a user failure,” she says. “Some people forget, or they make mistakes, or they take antibiotics. The coil . . . eliminates the user error factor, you cannot make mistakes, and that’s where the safety is better.”

Another good option is the barrier method. “Condoms can be very reliable for people in a stable relationship . . .” says Dr Galimberti, “they are less likely to be drunk . . . which is what can make the barrier method fail in the younger generation”.

“For women with hormone difficulties or who are worried about a particular side effect, it can be a good form of contraception.”

Of course, for the man in your life, there’s always a vasectomy, a procedure which she herself performs and which she says is quite popular in Ireland.

A vasectomy involves making a small incision to the scrotum under local anaesthetic, then cutting and sealing the tubes that carry sperm. “All you do is cut the way out for the sperm, you don’t do anything else. There is still the same ability to have sex, the same desire to have sex and the same sensation during sex. You still produce fluid during ejaculation; it just doesn’t contain any sperm.”

Men can expect to take painkillers and have some discomfort for a few days – but if the procedure is performed on a Friday, they can be back to work by Monday and can usually resume sexual activity within a week.

Non-reversible

The procedure should be regarded as non-reversible, warns Galimberti, and so is something partners need to think carefully about. “Sometimes relationships break down and they get into a new relationship. If that was to happen, they wouldn’t be able to have any more children.”

She says the method is used mostly by men in their late 30s or 40s who have completed their families or where their partner cannot get pregnant again due to medical issues.

An injected contraception, given every three months, can be less suited to older women she says because of concerns about its effect on bone density.

The most important thing for people choosing a contraceptive is to assess the risk, says Galimberti.“Go to your doctor, see if there are any risks for you. They can advise you on the best method.”