Contraception: The Pill, Patch and Vaginal Ring
A SELECTION OF METHODS OF CONTRACEPTION
Combined oral contraceptive pill ('the pill')
'The pill' is a highly effective method of contraception at all ages and is used by 8% of women over the age of 40. It may have special advantages for older women by helping heavy or painful periods or preventing ovarian cysts. It contains a combination of the two hormones, estrogen and progestogen which are given in a high enough dose to suppress ovarian function, preventing egg release. Women may continue with 'the pill' up to the age of 50 years provided they are fit, slim, non-smokers and have no risk factors for heart disease or stroke but in women who smoke, it should be stopped at the age of 35. 'The pill' must be prescribed by a doctor and the woman will need to have her blood pressure checked regularly. 'The pill' will not suit some women. It may be associated with a very slightly increased risk of breast cancer and should not be prescribed for women with migraine. Using 'the pill' in the long term protects a woman against both cancer of the ovary and of the lining of the womb(endometrium); a reduction of at least 50% in the risk of ovarian and endometrial cancer with combined pill use has been suggested, and this reduced risk continues for 15 years after stopping.
Extended pill taking
Traditionally the combined contraceptive pill has been taken daily for three weeks, followed by a seven day pill-free interval. It is now recognised that there is no real benefit in this form of administration and missing out this pill-free week can have great benefits in reducing bleeding, pelvic pain and headaches. These benefits can be particularly helpful for the perimenopausal woman when periods may be becoming heavier. New types of pill with reduced pill-free interval are being developed but meanwhile, after discussion with your doctor, it may be possible with ordinary pill packs just to keep taking the pill every day without a break. If a break-through bleed occurs, then the pill can be stopped for four days and then restarted.
HRT type estrogen containing pill
A new combined pill, Qlaira is now available which contains natural estradiol valerate as the estrogen component, rather than the synthetic estrogen ethinylestradiol. Ethinylestradiol is the usual component of the combined pill whereas estradiol valerate is an HRT type estrogen. This is a useful option for women in the perimenopause when it should control menopausal symptoms while providing contraception and good control of bleeding.
Evra is the first contraceptive patch available in the UK, and contains similar hormones to those in the combined pill. Each patch is worn for seven days and after three weeks of patches, a patch-free week follows, when a bleed is likely to occur. Continuous patch use as described in Extended pill taking is not recommended since circulating estrogen levels may become too high. Patches may be useful for women who have difficulty remembering a daily tablet, and can be considered in the perimenopause in women who are able to take the combined pill.
Nuvaring provides similar hormones to those in the combined pill and combined patch but in the form of a vaginal ring. It is a latex-free ring which women can insert into the vagina themselves and is worn for three weeks at a time, followed by a ring-free week. There are fewer reports of side effects compared to the combined pill and it can be considered by perimenopausal women who could take the combined pill.