Contraception information contributed by:
Dr.Ailsa Gebbie, MB ChB, MRCOG, MFFP, DCH.

Women are often tempted to (and frequently do!) abandon contraception before their periods stop completely. Although fertility at this stage of life is low, it is not zero. An unplanned pregnancy at an older age can be devastating for the individual woman and can present difficult choices. Healthcare professionals therefore recommend that women continue contraception until there is no further chance of ovulation and risk of pregnancy. Women in their late reproductive years may also have heavy, irregular or painful periods which must be taken into account when choosing a method of contraception. Many women around this stage of life will also be thinking about whether or not they wish to start hormone replacement therapy (HRT).

When to stop contraception

The general rules are to continue contraception for:

• One more year following the last spontaneous menstrual period if aged 50 years or over
• Two more years following the last spontaneous menstrual period if aged under 50 years

Factors affecting fertility

Fertility starts to decrease quite dramatically in women after their mid to late 30's. The main reason for this being a decline in quality of the eggs produced in a woman's ovaries. Pregnancies after the age of 50 years are rare. The oldest woman on record to have a successful pregnancy and birth in the world was aged 56 years in North America in 1956. The oldest woman in the UK was 54 years.

Women undergoing fertility treatments after the age of 40 years have very poor success rates. However, it is widely known that an older woman may well successfully conceive using healthy donor eggs from a younger woman. The oldest woman to have a child by this method is currently 65 years. The womb of an older woman can be hormonally stimulated to support a pregnancy at ages well beyond the natural menopause. This clearly demonstrates how the major limitation to successful pregnancy lies in quality or lack of eggs, and not in the function of the womb.

Another important factor affecting conception at older ages is frequency of sexual activity. Studies have demonstrated that married women of 40 years are likely, on average, to have sexual intercourse half as often as married women of 20 years. However, with high divorce rates, individuals may well be embarking on new relationships at this stage of life and an increased frequency of sexual activity.