At what age should a 51-year-old patient discontinue birth control pills (BCPs), also known as oral contraceptives?

From the Guidelines

A 51-year-old woman on birth control pills (BCPs) should generally discontinue them at age 55, when natural menopause typically occurs, as recommended by the most recent guidelines 1. This recommendation should be individualized based on her specific health factors, considering the risks of pregnancy at advanced maternal age against the risks of contraceptives. If she has no contraindications such as history of blood clots, stroke, certain cancers, uncontrolled hypertension, or smoking, she may safely continue BCPs until menopause, as the benefits of BCPs, including regulation of menstrual cycles and reduction of perimenopausal symptoms, may outweigh the risks 1. Some key points to consider when deciding when to stop BCPs include:

• The median age of menopause is approximately 51 years in North America, but can vary from 40 to 60 years 1
• There is no reliable laboratory test to confirm definitive loss of fertility in a woman, and the assessment of follicle-stimulating hormone levels may not be accurate 1
• Pregnancies among women of advanced reproductive age are at higher risk for maternal complications, such as hemorrhage, venous thromboembolism, and death, and fetal complications, such as spontaneous abortion, stillbirth, and congenital anomalies 1
• The risks associated with continuing contraception, including acute cardiovascular events and breast cancer, should also be considered 1 After age 50, consider transitioning to progestin-only methods, which carry lower thrombotic risk, or non-hormonal contraceptive options, as recommended by the U.S. Medical Eligibility Criteria 1. The decision to stop BCPs should involve a discussion with her healthcare provider about her individual risk factors, symptoms, and contraceptive needs, with periodic reassessment of the risk-benefit ratio as she ages 1.

From the FDA Drug Label

The Committee concluded that although cardiovascular disease risks may be increased with oral contraceptive use after age 40 in healthy non-smoking women (even with the newer low-dose formulations), there are also greater potential health risks associated with pregnancy in older women and with the alternative surgical and medical procedures which may be necessary if such women do not have access to effective and acceptable means of contraception.

The FDA drug label does not provide a specific age at which a 51-year-old patient should stop taking birth control pills. However, it mentions that cardiovascular disease risks may be increased with oral contraceptive use after age 40 in healthy non-smoking women.

• The label recommends that older women, as all women, who take oral contraceptives, should take an oral contraceptive which contains the least amount of estrogen and progestogen that is compatible with a low failure rate and individual patient needs 2. Given the patient's age (51 years), it is likely that she is postmenopausal or nearing menopause, and her need for birth control may be decreasing. However, without more information about the patient's individual situation and health status, it is difficult to provide a specific recommendation for when she should stop taking birth control pills. It is recommended that the patient consult with her healthcare provider to determine the best course of action for her individual situation.

From the Research

Stopping Birth Control Pills (BCPs)

• The decision to stop BCPs depends on various factors, including the woman's age, health status, and personal preferences 3, 4.
• For a 51-year-old woman, it is essential to consider the menopausal status, as the average age of menopause in the UK is 51 4.
• If the woman is still experiencing menstrual cycles, she may continue to use BCPs, but it is crucial to weigh the benefits and risks of continued use, particularly the increased risk of venous thrombosis 3, 5.

Menopausal Considerations

• As women approach menopause, the risk of pregnancy decreases, and the focus shifts to managing menopausal symptoms and preventing long-term health consequences, such as osteoporosis and cardiovascular disease 4, 6.
• Hormone replacement therapy (HRT) may be considered for menopausal women, but the decision should be individualized, taking into account the woman's medical history, risk factors, and personal preferences 4, 6, 5.

Recommendations

• There is no specific guideline on when to stop BCPs, but women over 50 years old should discuss their options with their healthcare provider, considering their individual circumstances and health status 3, 4.
• Alternative contraceptive methods, such as intrauterine devices or subdermal implants, may be recommended for women who wish to continue contraception or manage menopausal symptoms 3, 7.