Contraceptive Use Duration for a 45-Year-Old Woman
A 45-year-old woman should continue oral contraception until menopause or age 50-55 years if she wishes to prevent pregnancy, as recommended by both the American College of Obstetricians and Gynecologists and the North American Menopause Society. 1
Fertility in Perimenopausal Women
- The median age of menopause is approximately 51 years in North America but can vary from 40 to 60 years 1
- While the median age of definitive loss of natural fertility is 41 years, fertility can extend up to age 51 years 1, 2
- Spontaneous pregnancies, although uncommon, do occur in women over 44 years of age 1
- No reliable laboratory tests (including FSH levels) are available to confirm definitive loss of fertility 1, 2
Risk-Benefit Analysis
Risks of Pregnancy in Advanced Reproductive Age
Pregnancies in women over 44 years carry significantly higher risks:
- Maternal complications: hemorrhage, venous thromboembolism, and death 1
- Fetal complications: spontaneous abortion, stillbirth, and congenital anomalies 1
Risks of Continuing Oral Contraception
- Venous thromboembolism (VTE): Higher incidence in women aged 45-49 years compared to younger users, but no demonstrated interaction between hormonal contraception and increased age compared to baseline risk 1, 3
- Myocardial infarction: Higher relative risk among all OC users than non-users, but no demonstrated trend of increased risk with increasing age 1
- Breast cancer: Small but nonsignificant increased relative risks for breast cancer among women who used oral contraceptives when aged ≥40 years 1
Contraceptive Options for Women >45 Years
According to U.S. Medical Eligibility Criteria:
- Women aged >45 years can use (U.S. MEC 1) or generally can use (U.S. MEC 2) IUDs and hormonal contraception based on age alone 1
- Progestogen-only methods have advantages for women with cardiovascular risk factors 4
- The levonorgestrel-releasing intrauterine system is highly effective in controlling perimenopausal menstrual dysfunction 4
When to Discontinue Contraception
- Contraception should be continued until confirmed menopause or age 50-55 years 1, 2
- Hormone replacement therapy is not reliably contraceptive 4
- Women should continue contraception until they have reached natural sterility 4
Important Considerations
- Individual risk assessment is crucial - women with chronic conditions or cardiovascular risk factors may need to consider alternative contraceptive methods 1
- Smoking significantly increases risks associated with oral contraceptives, particularly VTE 3
- If fertility assessment is needed, discontinuation of OCPs for 1-3 months is recommended to allow return of normal hypothalamic-pituitary-ovarian function 2
The decision to continue oral contraception should be based on a thorough evaluation of individual risk factors, with particular attention to cardiovascular risk factors such as smoking, obesity, and hypertension, which may contraindicate the use of combined hormonal contraceptives in this age group.