Human Reproduction Update Advance Access originally published online on May 20, 2009
Human Reproduction Update 2009 15(6):599-612; doi:10.1093/humupd/dmp020
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Female contraception over 40
1 Correspondence address. P.G. Crosignani, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Via M. Fanti 6, 20122 Milano, Italy. E-mail: piergiorgio.crosignani{at}unimi.it
BACKGROUND: The majority of women 40–49 years of age need an effective method of contraception because the decline in fertility with age is an insufficient protection against unwanted pregnancy. Although pregnancy is less likely after the age of 40 years, the clinical and social consequences of an unexpected pregnancy are potentially detrimental. No contraceptive method is contraindicated by advanced reproductive age alone; thus there is a need to discuss the effectiveness, risks and non-contraceptive benefits of all family planning methods for women in this age group.
METHODS: MEDLINE searches were done by topic (epidemiology, age and reproduction, sexual function, delayed childbearing and specific contraceptive methods). The topic summaries were presented to the Workshop Group and omissions or disagreements were resolved by discussion.
RESULTS: The decline in fecundity in the fifth decade is insufficient for contraceptive purposes. Thus a family planning method is needed. Sterilization is by far the most common method in several countries. Copper intrauterine devices and hormone intrauterine systems have similar effectiveness, with fewer than 1% failures in the first year of typical use. Special considerations in this age group include the frequency of menstrual irregularity, sexual problems and the possibility of menopausal symptoms, all of which may respond to hormonal methods of contraception.
CONCLUSIONS: Women should be advised to continue with a contraceptive method until they have reached the menopause with its natural state of sterility.
Key words: ageing / contraception / family planning / sterilization / premenopause
A meeting was organized by ESHRE (August 1–September 1, 2008) to discuss the above subjects. The speakers included: D.T. Baird (Centre for Reproductive Biology, University of Edinburgh, UK), C. Castelo-Branco (Institute Clinic of Gynecology, Obstetrics, and Neonatology, Hospital Clinic, Faculty of Medicine, University of Barcelona, Barcelona, Spain), J. Collins (McMaster University, Hamilton, Canada), J.L.H. Evers (Dept. Obstet. Gynecol., Academic Hospital Maastricht, The Netherlands), A. Glasier (Family Planning and WW Services, Edinburgh, UK), C. La Vecchia (Istituto Mario Negri, Milano, Italy), H. Leridon (Director of Elfe Projet, INED, Paris, France), D.R. Mishell, Jr. (Dept. Obstet. Gynecol., Keck School of Med., U.S.C., Women's Hospital, Los Angeles, USA), K. Wellings (Sexual and Reproductive Health Research, Department of Public Health and Policy, LSHTM, London, UK). The discussants included: E. Arisi (Dipartimento Materno-Infantile, Trento, Italy), G. Benagiano (Dipartimento di Scienze Ginecologiche, Università di Roma, Italy), J. Bitzer (Universitätsspital Basel, Frauenklinik, Abteilungsleiter Gyn. Sozialmedizin und Psychosomatik, Basel, Switzerland), P.G. Crosignani (Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milano, Italy), E. Diczfalusy (Karolinska Institutet, Stockholm, Sweden), A. Lanzone (Clinica Ostetrica e Ginecologica, Policlinico A. Gemelli, Roma, Italy), S.O. Skouby (Department of Obstetrics and Gynecology, University of Copenhagen, Denmark) G. Stock (President, Berlin-Brandenburg Academy of Sciences and Humanities, Berlin, Germany) and A. Volpe (Dipartimento Integrato Materno Infantile, Università di Modena, Italy). The report was prepared by J. Collins and P.G. Crosignani. Received on February 17, 2009; revised March 23, 2009; accepted on April 23, 2009