EditorialImplantable hormonal contraception for women aged over 45 years
Section snippets
Do women over the age of 45 years need effective contraception?
Although abortion rates are declining for younger women, the number of women having abortion in their 40 s in the UK rose by almost one third in a decade [6]. This reflects increasing sexual activity among older women along with poor contraceptive use. In addition the average age for divorce for women in the UK is 41 years and they may need to revisit their contraceptive options in a new relationship [7]. Implants are long acting reversible contraceptives (LARCs) and are now considered one of
Contraindications for use
Although age alone does not contraindicate any contraceptive method, women over 45 years may be more likely to have medical conditions that make some contraceptive methods inappropriate. The UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) gives evidence-based recommendations on the use of contraceptive methods in the presence of different medical conditions (Table 1) [9].
There are few contraindications to implant use. They are not an effective method for women using enzyme
Other benefits and side effects of implants
The progestogen-only implant may alleviate dysmenorrhoea and help in the treatment of endometriosis [1]. Histological and cytological monitoring of implant users over 2 years showed a reduction in endometrial thickness and no change in cervical cytology [1]. In addition there is no conclusive evidence of a link with breast cancer risk and implant use shows little or no increased risk of venous thromboembolism, stroke or myocardial infarction [1].
Depot medroxyprogesterone acetate has been
Implant use, menopausal symptoms and diagnosis of menopause
Although some progestogens such as depot medroxyprogesterone acetate have been shown to relieve hot flushes [7] there is no data that the lower dose of progestogen release from implants is of benefit. It would be convenient for those perimenopausal requiring contraception that the progestogen they used could also offer endometrial protection if taking estrogen. There is currently no evidence that implants provide endometrial protection for women requiring estrogen for hot flush relief and no
Conclusion
Women over the age of 45 years who are sexually active require effective contraception. LARCs such as implants have one of the lowest failure rates and have few contraindications for this age group. The ENG implant is licensed for 3 years of use but new research suggests that the efficacy continues for up to 5 years, giving the same duration of contraceptive efficacy as the LNG implant [13]. Development of biodegradable implants, which do not need to be removed, is in the preclinical
Contributors
Helen Roberts is the sole author.
Conflict of interest
None declared.
Funding
The editorial was not funded.
Provenance and peer review
Commissioned, not externally peer reviewed.
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