| Combined hormonal methods (combined oral contraceptives [COCs], monthly injectables, combined patch, combined vaginal ring) |
- Women age 35 and older who smoke—regardless of how much—should not use COCs, the patch, or the vaginal ring.
- Women age 35 and older who smoke 15 or more cigarettes a day should not use monthly injectables.
- Women age 35 or older should not use COCs, monthly injectables, the patch, or the vaginal ring if they have migraine headaches (whether with migraine aura or not).
|
| Progestin-only methods (progestin-only pills, progestin-only injectables, implants) |
- A good choice for women who cannot use methods with estrogen.
- During use, DMPA decreases bone mineral density slightly. It is not known whether this decrease in bone density increases the risk of bone fracture later, after menopause.
|
| Emergency contraceptive pills |
- Can be used by women of any age, including those who cannot use hormonal methods on a continuing basis.
|
| Female sterilization and vasectomy |
- May be a good choice for older women and their partners who know they will not want more children.
- Older women are more likely to have conditions that require delay, referral, or caution for female sterilization.
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| Male and female condoms, diaphragms, spermicides, cervical caps and withdrawal |
- Protect older women well, considering women’s reduced fertility in the years before menopause.
- Affordable and convenient for women who may have occasional sex.
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| Intrauterine device (copper-bearing and hormonal IUDs) |
- Expulsion rates fall as women grow older, and are lowest in women over 40 years of age.
- Insertion may be more difficult due to tightening of the cervical canal.
|
| Fertility awareness methods |
- Lack of regular cycles before menopause makes it more difficult to use these methods reliably.
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