Can a 55-Year-Old Woman Stop Combined Oral Contraceptives?
Yes, a 55-year-old woman can and generally should stop taking combined oral contraceptives, as she has reached the upper limit of the recommended age range for contraceptive use (50-55 years) and the cardiovascular risks of COCs increase with age while fertility has almost certainly ceased. 1, 2
Timing of Discontinuation
Both the American College of Obstetricians and Gynecologists and the North American Menopause Society recommend that women continue contraceptive use until menopause or age 50-55 years. 1, 2
At age 55, this patient has reached the upper end of this recommended range, making discontinuation appropriate. 2
The median age of menopause is approximately 51 years in North America, though it can vary from 40 to 60 years. 1, 2
Risk-Benefit Analysis at Age 55
Cardiovascular risks favor discontinuation:
The incidence of venous thromboembolism is higher among oral contraceptive users aged ≥45 years compared with younger users. 1, 2
The relative risk for myocardial infarction is higher among all oral contraceptive users than nonusers. 1
Small increased relative risks for breast cancer exist among women aged ≥45 years whose last use of combined hormonal contraceptives was within the previous 5-9 years. 1
Fertility considerations support discontinuation:
Although spontaneous pregnancies can occur in women aged >44 years, they are uncommon. 1
The median age of definitive loss of natural fertility is 41 years but can range up to age 51 years. 1
At age 55, the risk of pregnancy is extremely low and does not justify continued COC use with its associated cardiovascular risks. 2
Important Caveats
No reliable test confirms infertility:
No reliable laboratory tests are available to confirm definitive loss of fertility in a woman. 1, 2
Assessment of follicle-stimulating hormone levels to determine when a woman is no longer fertile might not be accurate. 1
However, at age 55, clinical judgment strongly suggests menopause has occurred, particularly if the patient has experienced 12 months without menses. 2
Practical Discontinuation Approach
Simply stop the pills:
No tapering is required; COCs can be stopped abruptly without medical consequences. 1
If the patient has not yet experienced menopause (12 months without menses), monitor for return of menstrual cycles or menopausal symptoms. 2
Consider alternative management if needed:
If perimenopausal symptoms emerge after stopping COCs (hot flashes, night sweats, vaginal dryness), consider hormone replacement therapy rather than restarting COCs. 1
HRT formulations use lower doses of estrogen than COCs and have a more favorable risk profile for women in this age group. 1
Common Pitfall to Avoid
Do not continue COCs beyond age 55 for non-contraceptive benefits:
While COCs offer benefits such as decreased menstrual cramping, blood loss, and protection against endometrial and ovarian cancers, these benefits do not outweigh the cardiovascular risks in a 55-year-old woman. 3, 4
If management of perimenopausal symptoms is needed, hormone replacement therapy is the appropriate choice, not COCs. 1