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Senator Tammy Duckworth recently gave birth to daughter Maile a month after she turned Janet Jackson also had at Supermodel Iman had daughter Alexandria when she was Contrary to oft dispensed fertility advice, women are postponing pregnancy until or, in Nielsen's case, having her fifth child later in life at rising rates. Plenty of data exists to support this observation. According to a report from the CDCbirth rates declined for women aged 15—39 from to but rose for women aged 40—

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Many women are aware that their fertility declines from their mid 30s and think they can stop using contraception once they are in their 40s. They wrongly assume — because their fertility is lower, they have less sex and their periods may have become irregular — that contraception can be abandoned.

Fertility in women after age forty-five

However, women do still get pregnant in their late 40s and even into their 50s without using assisted reproduction techniquesso contraception should continue to be used every time they have sex if pregnancy is to be avoided.

An unplanned pregnancy at any age can pose problems, but particularly so for a woman in her 40s who may be beginning to enjoy more freedom as children grow up.

Furthermore, a pregnancy in older women is often associated with an increased of complications such as miscarriage, high blood pressure, diabetes and chromosomal problems with the baby, and consequently will need more careful monitoring. In recent years there have been many advances in contraception, and new methods may have additional health benefits such as lighter periods as well as providing excellent contraception.

How these pregnancies happen

This factsheet comments on various methods of contraception and discusses how appropriate they are for women in their 40s. Chlamydia, gonorrhoea, HIV and other STIs are on the increase in women in their 40s and 50s, so it is a good idea to be screened for infection before starting a new relationship.

This is an effective method for this age group, although some men may find them difficult if they have not used them for several years and may experience erection difficulties. As hormone levels change many women experience vaginal dryness which can cause discomfort during intercourse. Vaginal lubricants can be helpful, but care should be taken as any oil-based lubricant can cause condoms to split, leading to a risk of pregnancy and infection.

Some women may find these awkward if they have not used them before. They are well lubricated, so vaginal dryness should not be a problem.

Again, some women may find these awkward to use if they have not used them before, and if suffering from a small prolapse or stress incontinence may find them uncomfortable. Spermicides are an inherent part of using a diaphragm and these will provide additional lubrication.

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Women who have ly used a diaphragm or cap usually have no problem with these methods and can continue with their use right up until the menopause. The combined pill can safely be used until the age of 50, so long as there are no health risks such as smoking, obesity, high blood pressure etc that could lead to heart, stroke or blood clotting problems. Your doctor or nurse will be able to advise on this. The pill has several advantages for women in this age group as it will regulate periods, may help to maintain bone mineral density which is reduced after the menopausemay reduce blood loss and period pains and may also relieve some troublesome menopausal symptoms such as hot flushes and night sweats.

The efficacy, benefits, risks and side-effects are similar to the combined pill and again can be safely prescribed until 50 years old to those with no health risks.

All progestogen-only methods may cause irregular bleeding or even no bleeding at all. Medical advice should be sought if bleeding occurs after a long time with no periods. The progestogen-only pill is suitable for older women and can safely be used up until the age of Use of this method may continue until the age of There has been some concern that the injection may reduce bone mineral density and increase the risk of osteoporosis.

Women who have lifestyle or risk factors for osteoporosis smokers, fractures, steroid use, family history etc may wish to consider another method of contraception. The implant is suitable until the age of 50 and there are no anxieties about loss of bone mineral density with this method.

Older moms are on the rise

The hormone-releasing IUS is not only a highly effective method of contraception but it also ificantly reduces the amount of bleeding and period pain. The IUS is d for contraception for 5 years but if it is inserted over the age of 45 years it could remain in place for 7 years after discussion with your doctor or nurse.

It is only d for 4 years if used for HRT but is known to be effective for this purpose for 5 years. An IUD is a suitable method but may cause periods to become heavier or more painful, so may not be a good idea if periods are already causing a problem. If an IUD of any type is inserted over the age of 40 years then it can remain, without being changed, until the menopause. It should be removed one year after periods stop if this is over the age of 50 or two years after periods stop if this is under the age of Sterilisation both male and female is the most commonly used method for couples in their 40s.

However, sterilisation is a surgical procedure and it may not be justified for a woman with low fertility to undergo such a procedure when there are so many other highly effective options available. Women who have already been using natural methods of contraception timing of periods, changes in cervical mucus and body temperature can usually manage to continue to do so until the perimenopause.

However this can be more difficult to 45 for older woman to beginners at this stage in life due to variable cycle lengths and erratic ovulation. Emergency contraception can be used if a woman has had unprotected sex or if a form of contraception has failed a split condom or missed pills. There are two forms: the emergency contraceptive pill or the emergency intrauterine device IUD. There is no age limit for using emergency contraceptive pills levonorgestrel or ulipristal and they can be easily obtained from your doctor or in pharmacies without a prescription.

The emergency IUD has the advantage that it can remain in place and is an effective method of ongoing contraception. Contraception should be continued for at least one year after your last period if the periods stop after the age of 50, and for two years if your periods stop before the age of This is because sometimes periods may restart even after several months with no bleeding. However, if you are using progestogen-only hormonal contraception you may well have only occasional periods or no periods at all, thus making it difficult to tell if you are menopausal.

These methods can be safely used until the age of 50 55 years for the progestogen-only pill or the IUS. Your doctor may recommend a blood test which would give some guidance as to whether you are menopausal. If using combined hormonal contraception you will experience regular periods or withdrawal bleeds which again would mask one of the s of the menopause.

Blood tests are not reliable and not recommended if you are using combined hormonal methods. The average age for the menopause in the UK is 51 years but women in their 40s may start experiencing menopausal symptoms and consider taking hormone replacement therapy HRT. It is important to realise that HRT is not a method of contraception.

The IUS has the additional advantage of providing the progestogen component of HRT and so minimises bleeding problems and other side-effects that might occur from the progestogen.

Once HRT has been started, it can be difficult to know when contraception can be stopped since HRT will often produce regular monthly bleeds. It is best to continue contraception alongside HRT until the age of 55 as the vast majority of women will be menopausal by then. Website: www.

Phone: 24 hours Website: www. It is for your information and advice and should be used in consultation with your own medical practitioner. Contraception for the older woman.

The mystery of the disappearing ‘older’ women

The male condom This is an effective method for this age group, although some men may find them difficult if they have not used them for several years and may experience erection difficulties. The female condom Some women may find these awkward if they have not used them before.

The diaphragm and cap Again, some women may find these awkward to use if they have not used them before, and if suffering from a small prolapse or stress incontinence may find them uncomfortable. Hormonal methods The combined pill The combined pill can safely be used until the age of 50, so long as there are no health risks such as smoking, obesity, high blood pressure etc that could lead to heart, stroke or blood clotting problems.

What it's like to have a baby after 45

The contraceptive patch and vaginal ring The efficacy, benefits, risks and side-effects are similar to the combined pill and again can be safely prescribed until 50 years old to those with no health risks. Progestogen-only methods All progestogen-only methods may cause irregular bleeding or even no bleeding at all.

The progestogen-only pill POP or mini-pill The progestogen-only pill is suitable for older women and can safely be used up until the age of The contraceptive injection Use of this method may continue until the age of Contraceptive implants The implant is suitable until the age of 50 and there are no anxieties about loss of bone mineral density with this method.

Intrauterine system IUS The hormone-releasing IUS is not only a highly effective method of contraception but it also ificantly reduces the amount of bleeding and period pain. Other contraceptive methods Intrauterine devices IUD An IUD is a suitable method but may cause periods to become heavier or more painful, so may not be a good idea if periods are already causing a problem. Male and female sterilisation Sterilisation both male and female is the most commonly used method for couples in their 40s. Natural family planning Women who have already been using natural methods of contraception timing of periods, changes in cervical mucus and body temperature can usually manage to continue to do so until the perimenopause.

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Emergency contraception Emergency contraception can be used if a woman has had unprotected sex or if a form of contraception has failed a split condom or missed pills. When to stop contraception Contraception should be continued for at least one year after your last period if the periods stop after the age of 50, and for two years if your periods stop before the age of Hormone replacement therapy The average age for the menopause in the UK is 51 years but women in their 40s may start experiencing menopausal symptoms and consider taking hormone replacement therapy HRT.

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