This variety of methods has long been needed, experts say, because 40- and 50-somethings are a complex group. Some have had several children and are willing to have sterilization surgery. Others may want children, but not right now.
Traditionally, women 40 and older are the least likely to use birth control. Along with adolescents, they have the highest rates of abortion. At the same time, these women are more experienced at using contraception and follow instructions better.
When it comes to contraceptives for women 40 and older, "one size definitely does not fit all," said Dr. Vanessa Cullins, vice president for medical affairs of the Planned Parenthood Federation of America.
A review of the current science of contraception and women 40 and older was published recently in the New England Journal of Medicine. The author, University of Florida gynecologist Dr. Andrew Kaunitz, noted that the risk of dangerous blood clots rises sharply at age 40 for women who take birth control pills containing estrogen.
![](http://archives.lincolndailynews.com/2008/Apr/05/images/ads/current/action-rentals-&-sales-bch-033108.png)
The risk is even greater for overweight women, who also are more likely to have high blood pressure and diabetes.
But the dosage of estrogen in current birth control pills has been dramatically reduced. The pill is now considered a safe alternative for lean, healthy, older women Kaunitz and other experts said.
"It may not be well known that the current low-dose formulations are a reasonable option for healthy women in their 40s," said Dr. JoAnn Manson, a Harvard endocrinologist who wrote a book on menopausal hormone therapy.
The pill may be preferable for some women, because it can help control irregular menstrual bleeding and hot flashes and has been shown to reduce hip fractures and ovarian cancer, wrote Kaunitz. He has received fees or grants from several companies that make oral contraceptives.
But middle-aged women who are obese, smoke, have migraines, high blood pressure or certain other risk factors should be steered toward IUDs or progestin-only treatments like "mini-pills," experts said.
Higher breast cancer rates have been reported in older women who took estrogen-progestin pills for menopause. However, studies did not find an increased breast cancer risk in women 35 and older who took oral contraceptives.