Contraception at Different Ages: Which Is the Best Option

There are no universal ways to prevent unwanted pregnancy. The choice of method depends on many factors, and age is not the least of them. What is right for you?

Dr. Nona

Obstetrician-gynecologist, endocrinologist

It is always best to consult with your doctor to determine which contraception method is best for you. However, it is good to understand ahead of time some of the options for contraception, which depend on age.

First, you should understand the Pearl Index, which is an indicator that demonstrates the effectiveness of a particular method. The index is the number of pregnancies per 100 women, assuming the correct use of the contraceptive method. When calculating the index, individual characteristics, allergies, hormonal status, and age are not taken into account.

The index of the most common method of contraceptionā€”condomsā€”ranges from 2 to 18. In other words, between 2 and 18 women out of 100 became pregnant, despite using condoms with their partner. However, when used correctly, this method is guaranteed to protect against sexually transmitted diseases (STDs).

  • Pearl Index for interrupted intercourseā€”4ā€“22
  • Calendar methodā€”0.4ā€“24
  • Hormonal drugsā€”0.1ā€“9
  • Injections, implants, intrauterine ringā€”0.1ā€“3

Due to the characteristics of the body at different ages, it is worth looking not only at the index but also at the accompanying characteristics of contraceptives.

16ā€“19 years

For patients who are sexually active, doctors recommend choosing hormonal contraceptionā€”pills or a ring. Hormonal contraceptives play an important role in the prevention of diseases such as menstrual irregularities, infertility, and endometriosis.

The World Health Organization recommends three-phase or single-phase birth control pills for adolescents. The choice of a particular drug depends on the characteristics of the organism and usually occurs empirically. It is worth starting with pills with a minimum number of hormones and combining the use of contraceptives with the barrier method for the first 2ā€“3 months.

Six months later, it is recommended to do an ultrasound of the pelvic organs to make sure that there is no ovulation. The contraceptive method may be given up if the partners trust each other and have both passed the test for the absence of STDs.

Hormonal contraception is not prescribed for girls whose menstruation began less than two years before the onset of sexual activity. It is also not recommended for those who have problems with the thyroid gland, adrenal glands, or other hormonal pathologies, suffer from cardiovascular diseases, or experience increased blood clotting.

19ā€“35 years

For patients in this age range, doctors sometimes recommend giving up pills in favor of spirals. This method is relatively cheap, but most importantly, it does not require constant monitoring. The downside is the need for medical intervention both when installing and removing the spiral.

The hormonal coil is considered the best method of preventing unwanted pregnancy. However, after the age of 30, it makes sense to switch to low-dose combined oral contraceptives to avoid possible side effects including decreased libido, weight gain, and increased risk of blood clots.

The barrier method is also relevant, especially if there are contraindications or side effects to hormonal contraception.

35ā€“45 years

In this age range, you should take a blood test for coagulationā€”an expanded coagulogramā€”before giving preference to a certain method of contraception. If everything is in order, you can continue to take the appropriate pills or use the hormonal coil. If coagulation is increased, it is worth switching to the barrier method.

Additionally, you can opt for a contraceptive injection every 3 months. Against the background of hormonal contraception, the abundance and duration of menstruation may decrease, which many women consider an undeniable plus.

After 45 years

Ovarian function gradually decreases at age 45 and over. Despite this, the likelihood of becoming pregnant is not completely eliminated, since ovulation can occur even with an unstable and rare menstrual cycle.

However, after 45, many have already faced high blood pressure, interruptions in the work of the heart and vascular diseases, varicose veins, various diseases of internal organs, and hormonal imbalances. The main difficulties in choosing methods of contraception from pregnancy in women over 45 are associated with these risk factors.

Intrauterine devices for women aged 45ā€“50 are often contraindicated due to the presence of uterine fibroids and age-related changes in the cervix. The good old barrier method remains: it does not increase the risk of thrombosis, change blood pressure, or change liver function.

What changes after menopause?

Menopause is a serious hormonal change in the whole body as a result of which metabolism changes, muscle mass is lost and fat accumulates. For many women, physiological changes lead to a decrease or even disappearance of libido, but it should be remembered that with the beginning of a complete restructuring of the body to a new regime the libido will come back, and the ability to conceive will remain for several more years. In some women, menopause increases sexual desireā€”which is often associated with a lessening fear of unwanted pregnancy.

Hormonal contraception in the postmenopausal period is quite useless and can even be harmful. Therefore, after the complete ending of menstruation, doctors recommend protecting yourself with a barrier method for the following year. After that, you can completely give up contraception.

23 March 2021

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