How You Can Avoid an Accidental Mid-Life Pregnancy

Studies show over half of unplanned pregnancies in women age 35 and up end in abortion. Even though you may have reduced estrogen and fewer viable eggs, sexually active women who are still menstruating need to use some form of contraception.

Surprising Research Results

In a study of 55 women with a median age of 72, 55 percent said their doctors discussed sex with them after they turned 40. That means physicians treating the other 45 percent probably didn’t bring up contraception. Another study showed sexually active women in their late 30s and early 40s thought not getting pregnant confirmed they were infertile — in reality, there were probably extenuating circumstances. All this miscommunication and misinformation leads to some scary . In the U.S., 29 percent of pregnancies in women 35 to 39 and 38 percent of pregnancies in those 40 and older are accidental. Out of those unplanned pregnancies, 56 percent end in abortion. While it’s true fertility declines with age, up to 80 percent of women between the ages of 40 and 43 still can get pregnant. Until you reach menopause, 12 months after your final period, you need to use some form of birth control to avoid an unexpected mid-life pregnancy. Reversible Contraception If you want the option of a future planned pregnancy, pick a reversible method, like one of these:

Birth Control Pills

The pill comes in various formulations. Some help to relieve perimenopausal symptoms.

• Combination-hormone pills. Specific amounts of estrogen and progestin hormones block ovulation and prevent fertilization.
• Progestin-only mini-pill. This estrogen-free contraceptive thickens your cervical mucus and thins your uterine lining to prevent sperm from reaching and fertilizing an egg. If you’re more than three hours late taking your mini-pill, use a back-up birth control method.
• NuvaRing. Insert this thin, transparent, flexible ring into your vagina. NuvaRing releases the same hormones as combination oral contraceptives. It blocks ovulation and alters your uterine lining to prevent fertilization and implantation. Leave each one-month ring in for three weeks and then remove it for one week.
• Ortho Evra. Apply this thin, flexible birth control patch to your lower abdomen, buttocks or upper body. Its continuous estrogen and progestin flow prevents ovulation. Use one patch per week for a three-week period and then go without it for one week.
• Depo-Provera. Every three months, a synthetic-progesterone injection can prevent ovulation. Depo-Provera also thickens your cervical mucus and changes your uterine lining to inhibit sperm from entering and surviving in your uterus.
• Implanon. A flexible matchstick-sized rod, inserted under your upper arm’s skin, releases a steady dose of progestin to prevent fertilization. A doctor must insert and remove this implant, which can remain in place for up to three years.

Estrogen-Based Rings and Patches

Other Hormonal Options

IUDs

Your doctor must insert and remove both hormonal and non-hormonal long-acting reversible contraceptives (LARCs).

• Mirena IUD. Use this small, T-shaped, flexible plastic intrauterine device for up to five years. It releases levonorgestrel to prevent sperm from reaching an egg and stops a fertilized egg from implanting. Bayer, the manufacturer, recommends Mirena for women who have given birth.
• ParaGard copper IUD. Use this hormone-free version for up to 12 years. A tiny filament wrapped around the T releases a minimal amount of copper, which acts as a spermicide to prevent pregnancy.

Non-Hormonal Alternatives

While diaphragms, cervical caps and over-the-counter spermicides, sponges and condoms provide hormone-free protection, they’re less effective than hormonal contraceptive forms. Permanent Sterilization Choose sterilization when you want to prevent pregnancy forever. These procedures are normally a permanent contraceptive method; however, doctors can reverse the process in some cases. Be sure you don’t intend to have future children before your procedure.

Female Sterilization

The most common birth control form overall, female sterilization is most often the choice of women 35 and up. Choose between two procedures:

• Surgical tubal ligation. A surgeon performs this method while you’re under general anesthesia in a hospital. He inserts a laparoscope through a small abdominal incision. Then he blocks your tubes with a ring or burns and clips them shut. Recovery is two or more weeks.
• Fallopian tube occlusion. You may have this minimally invasive nonsurgical procedure in your doctor’s office with local or general anesthesia. Using a hysteroscope, your doctor will insert a small device through your vagina, cervix and uterus into your fallopian tube. Over a period of three months, a permanent tissue barrier forms to prevent sperm from reaching your egg. Recovery is within 24 hours. An x-ray will confirm complete blockage after three months.

Male Sterilization

A vasectomy ensures no sperm exit a man’s penis during ejaculation. Under local anesthesia in a clinic, your urologist or surgeon makes two small openings in the scrotum. Then he severs the vas deferens (sperm-carrying tubes from testicles to urethra) and closes off the open ends. After a vasectomy, a man may feel tenderness or bruising around his incision site. Use a secondary birth control form until his ejaculate fluid is sperm free, usually after 10 to 20 ejaculations. Contraceptive Consistency Use whatever birth control method you choose responsibly and consistently until you reach menopause. While avoiding an untimely mid-life pregnancy may be your main goal, remember condoms still are the only contraception that prevents STDs.