10 April 2008

Birth control – the good news

Birth control options are growing for women 40 and older - a group that once viewed its choices as pretty much limited to tube-tying surgery and condoms.

Birth control options are growing for women 40 and older - a group that once viewed its choices as pretty much limited to tube-tying surgery and condoms.

For them, the pill is back. So is the IUD. The reason is that both are safer. There is even a nonsurgical method of tube-tying.

Such options have long been needed, experts say, because 40- and 50-somethings are a complex group. Some have had several children and are willing to have sterilisation surgery. Others may want children, but not right now.

High abortion rates
Traditionally, women 40 and older are the least likely to use birth control. Along with adolescents, they have the highest rates of abortion. At the same time, these women are more experienced at using contraception and follow instructions better.

When it comes to contraceptives for women 40 and older, "one size definitely does not fit all," said Dr Vanessa Cullins, vice president for medical affairs of the Planned Parenthood Federation of America.

A review of the current science of contraception and women 40 and older was published recently in the New England Journal of Medicine.

Risk of blood clots
The author, University of Florida gynaecologist Dr Andrew Kaunitz, noted that the risk of dangerous blood clots rises sharply at age 40 for women who take birth control pills containing oestrogen.

The risk is even greater for overweight women, who also are more likely to have high blood pressure and diabetes.

But the dosage of oestrogen in current birth control pills has been dramatically reduced. The pill is now considered a safe alternative for lean, healthy, older women Kaunitz and other experts said.

"It may not be well known that the current low-dose formulations are a reasonable option for healthy women in their 40s," said Dr JoAnn Manson, a Harvard endocrinologist who wrote a book on menopausal hormone therapy.

The pill may be preferable for some women, because it can help control irregular menstrual bleeding and hot flashes and has been shown to reduce hip fractures and ovarian cancer, wrote Kaunitz. He has received fees or grants from several companies that make oral contraceptives.

Good alternatives
But middle-aged women who are obese, smoke, have migraines, high blood pressure or certain other risk factors should be steered toward IUDs or progestin-only treatments like "mini-pills," experts said.

Higher breast cancer rates have been reported in older women who took oestrogen-progestin pills for menopause. However, studies did not find an increased breast cancer risk in women 35 and older who took oral contraceptives.

The most common form of contraception for women 40 and older continues to be sterilisation - a category that counts tubal ligations (tube-tying) in women as well as vasectomies in their male partners.

Increasingly, gynaecologists are offering a newer type of tubal ligation that is nonsurgical. The procedure, called Essure, was approved by the US government in 2002. Instead of cutting through the abdomen to cut and tie the fallopian tubes, a doctor works through the cervix, using a thin tube to thread small devices into each fallopian tube. These cause scarring, which in about three months plugs the tubes, stopping eggs from the ovaries from reaching the uterus.

Also relatively new is a product called Implanon, approved in the US in 2006. It's a matchstick-sized plastic rod, placed under the skin of the upper arm, that is a more modern cousin of Norplant and can last about three years.

"Things have definitely changed. There are a lot more options for older women than there used to be," said Dr Erika Banks, director of gynaecology at New York City's Montefiore Medical Centre. – (Sapa-AP)

Read more:
Sex Zone
Contraception Centre

April 2008




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