Methods of reversible contraception, oral contraceptives, intrauterine devices, and Norplant (systemic progestin-only contraceptive; Wyeth-Ayerst, Radnor, PA), can be used for women over 35 years of age. Oral contraceptive formulations are safe and effective for healthy women up to the age of menopause. Oral contraceptives in women who do not smoke cigarettes do not result in a significant increased risk for cardiovascular disease. The incidence of breast cancer is not increased in women who have used oral contraceptives. A slight increase was found in younger women who had been on oral contraceptives based on a reanalysis of the contraceptive and steroid hormone study of the Centers for Disease Control. A reduction in the incidence of ovarian epithelial neoplasia by 40% was found in three European case-control studies. Two intrauterine devices are currently available on the US market: Paragard (GynoPharma, Somerville, NJ) and Progestasert (Alza Corp., Palo Alto, CA). Both of these provide highly effective contraception. A World Health Organization prospective randomized study found that there was an increase in pelvic inflammatory disease rates in the first 20 days after intrauterine device insertion. The intrauterine device itself did not increase the pelvic inflammatory disease incidence rates. The Norplant system exerts its contraceptive action through ovulation inhibition and alteration of cervical mucus. The major consumer complaint is irregular or prolonged uterine bleeding, which can be controlled by oral estrogen.
PIP: US women over 35 years old continue to need reversible contraception. Most women in this age group who need reversible contraception use the condom, diaphragm, spermicides, IUDs, or oral contraceptives (OCs). The most effective reversible contraceptives are OCs, the IUD, and the systemic contraceptive, Norplant. Healthy women older than 35 who do not smoke and have no coronary artery disease risk factors can safely use low-dose OCs. OCs do not increase the incidence of breast cancer. They appear to protect from epithelial ovarian neoplasm and functional ovarian cysts. Further, they reduce the amount and duration of vaginal bleeding. IUD use has fallen in the US due to the negative publicity of increased risk of pelvic inflammatory disease (PID). Studies have shown, however, that older women who are in a stable monogamous relationship can use an IUD without increasing their risk of PID. The only 2 IUDs available in the US are Progestasert, which releases progesterone, and Paragard T380A, which releases copper. Progestasert reduces the amount of bleeding often associated with IUD use. The risk of ectopic pregnancy is slightly increased in IUD users. Older women can choose the subdermal implant, Norplant, which is effective for 5 years. Its major disadvantage is irregular vaginal spotting or bleeding, but administration of oral estrogen controls this effect. Norplant suppresses ovulation and alters cervical mucus.