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Why the Combined Pill is Not Suitable for Over 35s in Some Cases

5 min read
women's health Reproductive Health Contraception

According to the Mayo Clinic, while many healthy non-smoking women can continue using the combined pill past 35, it is not recommended for those with specific health risks. This is because the estrogen component in the combined pill, when combined with age and certain lifestyle factors, significantly increases the risk of serious cardiovascular events. Understanding why is the combined pill not suitable for over 35s requires a look at how hormonal contraceptives interact with age-related health changes.

Quick Summary

The combined oral contraceptive is not suitable for women over 35 who smoke or have cardiovascular risk factors due to an increased risk of blood clots, heart attack, and stroke. Age amplifies the risks associated with the estrogen component, requiring a thorough medical evaluation for safe contraception choices.

Key Points

  • Increased Risk of Blood Clots: Women over 35 have a higher natural risk of blood clots, and the estrogen in the combined pill further increases this risk, potentially leading to deep vein thrombosis, heart attack, or stroke.

  • Smoking Magnifies Cardiovascular Risks: Smoking is a major contraindication for the combined pill in women over 35, as it dramatically increases the risk of serious cardiovascular events when combined with estrogen.

  • Health Conditions are a Factor: Pre-existing conditions like uncontrolled high blood pressure, diabetes with complications, and a history of blood clots or stroke make the combined pill unsuitable and unsafe.

  • Migraines with Aura are a Red Flag: Migraine with aura significantly increases the stroke risk associated with combined hormonal contraceptives, warranting the use of alternative methods.

  • Progestin-Only Options are Safer: Alternatives containing only progestin, such as the mini-pill, hormonal IUDs, or implants, are generally much safer for women over 35 with specific risk factors.

In This Article

Increased Cardiovascular Risks with Age

For many women, the combined oral contraceptive pill (COC) is a safe and effective birth control method. However, its safety profile changes significantly for women over the age of 35, especially in the presence of additional risk factors. The primary reason for this caution is the elevated risk of cardiovascular events, which naturally increase with age. The estrogen found in the combined pill can contribute to blood clot formation, and this effect is compounded by the body's natural aging process.

The Compounding Effect of Smoking

Smoking is one of the most critical risk factors that makes the combined pill unsuitable for women over 35. The combination of estrogen from the pill and the cardiovascular damage caused by smoking creates a particularly dangerous synergy.

  • For women over 35 who smoke 15 or more cigarettes a day, the risk of serious cardiovascular events, such as heart attack and stroke, is significantly heightened, making the combined pill an unsafe option.
  • Even in light smokers, healthcare providers are advised to consider the increased risk and discuss alternative, safer contraceptive methods.

High Blood Pressure and Other Health Conditions

Beyond smoking, other health issues that become more prevalent with age can make the combined pill risky. Women over 35 with these conditions are often advised to avoid estrogen-based contraception.

  • Uncontrolled High Blood Pressure: Estrogen can increase blood pressure, which can lead to a heart attack or stroke, especially in women with poorly controlled hypertension.
  • History of Blood Clots or Stroke: Any personal history of deep vein thrombosis (DVT), pulmonary embolism, stroke, or other clotting disorders is a major contraindication for the combined pill.
  • Diabetes with Complications: Women over 35 with diabetes-related complications, such as kidney, nerve, or eye disease, are at a higher risk of cardiovascular events and should avoid the combined pill.
  • Migraines with Aura: The presence of migraine with aura is a known risk factor for stroke, and this risk is magnified when combined with estrogen-based contraception.

Comparison of Combined Pill vs. Progestin-Only Options Over 35

Feature Combined Pill (Estrogen & Progestin) Progestin-Only Options (Mini-pill, Implant, IUD)
Hormone Type Contains both estrogen and progestin. Contains only progestin.
Primary Risk Increased risk of blood clots, heart attack, and stroke, especially with risk factors like smoking, high blood pressure, and obesity. Does not carry the same increased cardiovascular risks as estrogen, making it safer for many over-35 women.
Effect on Blood Pressure Can increase blood pressure. Does not typically affect blood pressure.
Menstrual Benefits Can regulate periods and reduce heavy or painful bleeding. May cause irregular bleeding or no periods at all.
Candidate Profile Generally healthy, non-smoking women over 35 without a history of cardiovascular issues. Excellent for women over 35 who smoke, have high blood pressure, or a history of blood clots.
Administration Requires daily pill-taking. Includes pills, long-acting reversible options (implants, IUDs), or injections.

Alternative Contraceptive Options for Women Over 35

If the combined pill is deemed unsafe, women over 35 have numerous reliable contraceptive options available after consulting with a healthcare provider. These alternatives often avoid the risks associated with estrogen.

  • Progestin-Only Pill (Mini-Pill): A daily pill containing only progestin. It's a safe option for women over 35 with risk factors like smoking or hypertension.
  • Intrauterine Devices (IUDs): Both hormonal IUDs (releasing progestin) and non-hormonal copper IUDs are highly effective, long-term options.
  • Contraceptive Implant: A small rod inserted under the skin of the upper arm that releases progestin and offers long-term protection.
  • Contraceptive Injection: A progestin injection administered every few months, suitable for many women over 35.
  • Barrier Methods: Condoms, diaphragms, and cervical caps offer non-hormonal protection, though they require consistent use to be effective.

Conclusion: Making an Informed Choice

While the combined pill isn't suitable for all women over 35, it's not universally off-limits. The key is a personalized health assessment by a medical professional. For healthy, non-smoking women, a low-dose combined pill might still be an option. However, those with risk factors like smoking, high blood pressure, a history of blood clots, or migraines with aura must consider the significantly elevated cardiovascular risks and explore the numerous safer alternatives available. An open discussion with a doctor is essential to determine the most appropriate and safe contraceptive method for your individual health profile, ensuring that your choice supports your long-term well-being.

Visit the CDC's website for comprehensive information on contraception

Frequently Asked Questions

Is the combined pill ever suitable for women over 35?

Yes, the combined pill can be suitable for women over 35 who are healthy, do not smoke, and do not have other cardiovascular risk factors like high blood pressure or a history of blood clots. Your healthcare provider will make this determination based on a full health assessment.

What are the main cardiovascular risks for combined pill users over 35?

The primary cardiovascular risks include an increased chance of blood clots (deep vein thrombosis and pulmonary embolism), heart attack, and stroke, with the risk amplified by factors like smoking and high blood pressure.

Why does smoking increase the risk so much for older combined pill users?

Both estrogen in the pill and the act of smoking can increase the risk of blood clots. When combined in women over 35, who already have an elevated baseline risk due to age, the danger becomes significantly higher.

Are there any progestin-only options for women over 35?

Yes, progestin-only options are often a safer alternative for women over 35 with specific risk factors. These include the mini-pill, hormonal IUDs (e.g., Mirena), and contraceptive implants.

What if I have migraines? Can I use the combined pill?

If you experience migraines with aura, the combined pill is generally not recommended due to a higher risk of stroke. Women with migraines should discuss this with their doctor to explore other options.

What are the best long-term contraception options for women over 35?

For long-term, highly effective contraception, hormonal or copper IUDs and the contraceptive implant are excellent choices that are safe for many women over 35.

How will I know when to stop using contraception as I approach menopause?

Contraception should be continued until menopause is confirmed. If you are using hormonal contraception that masks your cycles, your healthcare provider may suggest continuing contraception until age 55 or running specific blood tests to determine your menopausal status.

Citations

Frequently Asked Questions

No, if you are over 35 and smoke, the combined pill is not considered a safe option due to the significantly increased risk of serious cardiovascular events like heart attack and stroke.

Age is a factor in determining the safety of specific methods, particularly those containing estrogen. Many methods, including progestin-only options and IUDs, are safe for women of all reproductive ages, even over 35.

If you have poorly controlled high blood pressure, the combined pill is generally not recommended, especially if you are over 35, as the estrogen can raise blood pressure further.

For women over 35 with cardiovascular risk factors, progestin-only methods like the mini-pill, implant, or hormonal IUD, as well as non-hormonal options like the copper IUD, are typically considered safer than the combined pill.

While modern pills contain lower doses of estrogen than older formulations, the risk of venous thromboembolism increases with age regardless of the dosage. The risk is still significant for those with other health concerns or who smoke.

The research on combined oral contraceptives and cancer risk is complex. Some studies indicate a slightly increased risk of cervical and breast cancers in current users, while other studies show a reduced risk of endometrial and ovarian cancers. A doctor can help you weigh these risks based on your personal health history.

Reaching age 35 does not automatically mean you must stop. It is a time for re-evaluation with your healthcare provider to assess your current health, lifestyle, and risk factors. If you are healthy and don't smoke, you may continue.

References

  1. 1
    Birth control pill FAQ: Benefits, risks and choices
  2. 2
    Heart Disease & Birth Control
  3. 3
    I’m a smoker. What birth control options are best for me?
  4. 4
    Best Birth Control Options for Women Over 35
  5. 5
    Combination birth control pills

Related Topics

#cardiovascular disease #health risks #smoking #hormonal contraception #contraceptive options #blood clots #over 35 #combined pill

Medical Disclaimer

This content is for informational purposes only and should not replace professional medical advice. Always consult a qualified healthcare provider regarding personal health decisions.