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This paper discusses the dilemma faced by older women in finding a method of contraception that is both safe and effective. For normotensive, slim women over 35 years of age who have never smoked, combined oral contraceptives (OCs) still provide a viable method of fertility control. However, there is a 2-3-fold increased risk of mortality from cerebrovascular and preipheral vascular disease among OC users who smoke. The progestagen-only pill is free of adverse cardiovascular effects but may produce irregular menses and intermenstrual bleeding. Depo-Provera has been used in older women as a shortterm method of contraception and menstrual regulation. An investigation of the effects of estradiol implants in premenopausal women produced excellent results both in amelioration of incidental symptons and as a contraceptive, although a more extensive trail is needed. Since the risk of pelvic inflammatory disease is low amoung older multigravid women, the IUD is an attractive contraceptive alternative. Vaginal laxity and cervical deformities resulting from childbirth may reduce the efficiency of the diaphragm. Sporadic ovulation and unpredictable menstruation make natural or rhythm methods of fertility control inappropriate for older women. Female laparoscopic sterilization is becoming increasingly acceptable among women in this age group. Overall, the scope and choice of contraceptive methods available to women over 35 years of age is expanding.
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PMID:Contraception for the older woman. 673 55

FDA has approved medroxyprogesterone acetate as Depo Provera Contraceptive Injection, effective for 3 months in preventing pregnancy in women. In clinical studies, the drug's failure rate was less than 1%. However, physicians must ensure that patients receive injections on schedule to prevent pregnancy. The recommended dose is 150 mg administered every 3 months by deep, intramuscular injection in the gluteal or deltoid muscle. Most women in clinical studies of Depo Provera experienced menstrual irregularities. As use continued, amenorrhea became common, reported by 57% of the women by the end of a year of treatment. Other side effects included weight gain, headache, nervousness, abdominal pain or discomfort, dizziness, and asthenia. Physicians should administer the drug only to women found not to be pregnant, because fetal exposure may lead to low birth weight and other problems. Recent data have demonstrated that longterm use may contribute to osteoporosis, and the drug's manufacturer, the Upjohn Company of Kalamazoo, Michigan, will conduct additional research to study this possible side effect. Contraindications are similar to those for other contraceptives and include undiagnosed vaginal bleeding, known or suspected malignancy of breast, thromboembolic disorders, cerebral vascular disease, and liver dysfunction. Depo Provera was developed in the 1960s and has been approved for contraception in many other countries. When FDA first reviewed data on the drug in the 1970s, animal studies raised questions about its potential to cause breast cancer. Since then, longterm controlled clinical studies in other countries have shown a risk of breast cancer comparable to oral contraceptives, and no increased risk for ovarian, liver, or cervical cancer. The studies also showed that the contraceptive injection reduced the risk of endometrial cancer. FDA approved the drug October 29, 1992.
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PMID:3-month contraceptive injection approved. 1231 15