The pill after age 35
Dear Dr Mitchell,
Is taking the pill past 35 safe? I have heard conflicting reports, but I have been on the pill for the past several years and it has proved to be reliable. I have none of the risk factors. Can I continue taking it indefinitely, or should I switch to another method?
The oral contraceptive pill is a safe and reliable form of contraception when taken properly. All hormonal contraceptives containing oestrogen should be taken with caution once you have reached age 40.
There are preparations on the market containing a really low dosage of oestrogen and these are preferred to regular dose formularies when you get older, especially as you approach 40 years.
There are certain risk factors that make the use of oestrogen dangerous as you get older — smoking, obesity, diabetes mellitus, hypertension, ischemic heart disease, a family history of breast cancer and a history of having a clot in the leg or pelvis (deep vein thrombosis). Women who have any of these risk factors should consider using progesterone-only contraception such as the depo provera injection, progesterone-only pill, barrier methods (female and male condoms), the intrauterine contraceptive device or consider tubal ligation or vasectomy.
Women who use the oral contraceptive pills from an early age and continue until an advanced age are at increased risk for cervical cancer. It is important to do regular Pap smears and ask your doctor about vaccination against the human papilloma virus (HPV). This is a three-dose vaccine schedule which is given over six months. The first one is given followed by a second in one month and then a final one six months later. Women with a history of an abnormal Pap smear should consider using an alternative method to the oral contraceptive pill as they get older.
The risk for cancer of the cervix increases beyond age 30 years since the risk of persistent HPV infection increases as you get older, thus resulting in an increased risk for cervical cancer.
Long-term use of the oral contraceptive pill, however, reduces the risk of cancer of the ovaries and uterus. However, because of the risk of breast cancer and cervical cancer, older women should consider using a method of contraception that has no oestrogen.
You should consult your doctor about using the intrauterine contraceptive device if it is not contraindicated, or even doing sterilisation if there is no desire for future fertility.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver. com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax 968-2025. Dr Mitchell cannot provide personal responses.
DISCLAIMER: The contents of this article are for informational purposes only and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
