Depot medroxyprogesterone acetate (DMPA) was connected with a reduction in bone mineral density (BMD) in women of every age group. 1 Reassuringly, scientific studies viewing females over 40 exactly who use DMPA demonstrate that although users feel an initial reduction in BMD with usage, this isn’t repeated or worsened by menopause. 1 people over 40 with added possibilities issues for weakening of bones are encouraged to give consideration to alternate methods.
Ladies over 40 just who use DMPA for contraception ought to be reviewed frequently to assess the benefits and risks of continuing need. 1 Routine tabs on serum oestrogen degrees, lipids, or bone relative density just isn’t at this time advised. For ladies aged 18aˆ“45 age, DMPA is recognized as UKMEC group 1; whereas for women aged over 45 ages, DMPA is regarded as UKMEC class 2. 2 For ladies elderly over 50, the guide advises that ladies should always be directed to switch to an alternate method. 1
DMPA can reduce menstrual soreness and HMB and will frequently result amenorrhoea, which a lot of women find useful. 1 this may also reduced the risk of endometrial and ovarian types of cancer, even though the evidence is restricted. 1 there can be a weakened positive organization between cervical cancer tumors and employ of DMPA for 5 years or lengthier (evidence might be at the mercy of confounding factors). Threat generally seems to reduce eventually after stopping. 1
People elderly over 40 years with added possibilities facets for weakening of bones should see renewable birth control methods. At years 50, all females is instructed to switch to an alternative method. Any girl receiving non-contraceptive advantages which would like to manage after years 50 must be considered on someone grounds. 1
DMPA is not trained for usage as endometrial safeguards with oestrogen substitution and should never be utilized once the progestogen component of HRT. 1
Progestogen-only capsule (POP)
tablet (POP). 1
Desogestrel pop music can reduce monthly period and ovulatory soreness; 97% of females come to be anovulatory. 1 However, nearly half women utilizing all types of pop music have changed bleeding designs, 1 which some lady discover it unsatisfactory.
There is absolutely no get older restriction the pop music and it may be utilized securely until a female no more need contraception.
The pop music just isn’t registered for use as endometrial protection with oestrogen substitution and really should not be put given that progestogen component of HRT.
Matched hormone contraception
With increasing years appear increasing background danger for several morbidities that may be exacerbated by matched hormone contraception (CHC). As a result, the guideline recommends that ladies aged over 40 should be counselled regarding alternative effective ways of contraception, and switch to a safer method at age 50. Any girl getting non-contraceptive positive who wishes to continue after get older 50 must be thought about on a person grounds. 1
Evidence shows that CHC has a confident impact on BMD and decreasing perimenopausal warning signs (such as unpredictable and/or significant bleeding, and vasomotor warning signs). 1 it’s also utilized as an option to HRT. Ladies who use CHC has a lowered danger of ovarian and endometrial types of cancer, the advantage of which persists years after cessation. 1
However, CHC is related to a little enhanced risk of cancer of the breast, the chance of which furthermore boosts as we grow old. There is no evident increasing danger years after cessation of CHC. 1
The risk of venous thromboembolism (VTE) boost sharply over the age of 40 years, which means that consideration of some other possibility issue for VTE is necessary when it comes to CHC within age-group. Weight is an important danger factor; muscles mass index should be assessed frequently. 1 The risk of VTE is actually finest on initiation of CHC and that increased threat recurs if CHC was ended and restarted. 1 The guide consequently recommends against recurring symptoms of stopping/starting CHC, for example, determine follicle stimulating hormones (FSH) stages. Products containing larger 
doses of oestrogen is connected to better danger of VTE, swing, and cardiovascular disease. 1 When prescribing COC for females over 40, first choice need a preparation with a‰¤30 mcg ethinylestradiol. This needs to be combined with either levonorgestrel or norethisterone as this combination confers the lowest VTE hazard (see Table 1). 9
Extended or continuous CHC use may provide better control of menstrual and perimenopausal symptoms by avoiding a hormone-free interval. 1 The FSRH CHC guideline provides information around tailoring regimens. 10
Girls elderly more 35 whom smoke and all of women elderly over 50 (despite smoking cigarettes reputation) ought to be urged to avoid CHC as threats exceed positive. 1