Many non-smoking healthy women can continue to use OCPs safely past 35 years of age. The hormone content of OCPs may alleviate some menopausal signs and symptoms, help maintain bone integrity, and reduce risks of ovarian and endometrial cancer. On the other hand age and obesity (which is frequently increased in prevalence with aging) are risk factors for cardiovascular disease. VTE increases with age and the risk of VTE attributable to combination OC use increases substantially for women 40 years. Although data on the impact of OC use by women in their 40s and 50s on breast cancer risk is limited, information on the effect of menopausal combined hormone therapy on breast cancer risk should make clinicians cautious and individualize OC use based on risk, patient preferences and review of alternatives. The use of serum FSH in deciding whether a woman is menopausal can be expensive and misleading. Most experts would recommend against using the test to determine whether a woman in her late 40s and early 50s remains “fertile.” If a woman is otherwise healthy and desires combination hormonal contraception after discussion of risks and benefits she may remain on these until 50 to 55 years of age. The use of OCPs in women over 40 years of age has been shown to reduce the risk of hip fracture by 44% and strengthen bone density. Subdermal implants and IUDs may be especially good choices as they confer contraceptive efficacy for 3–7 years after which time the reproductive capacity may diminish. Because fertility declines in the late 40s and early 50s, barrier methods may be relatively more effective.
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