The Pill and the Seasoned Woman

For years, oral contraceptives carried warnings that they were unsafe for use after age 35. That changed in 1989, when the FDA declared the newer, far-lower-dose pills safe throughout the reproductive years for women who don't smoke or have other risk factors like extreme obesity or some blood-clotting disorders.

Hormone replacement therapy (HRT) after menopause uses hormones similar to those of the pill, albeit in lower doses. Researchers originally thought HRT would reduce the risks of heart attack and stroke among postmenopausal women. But in 2002, researchers discovered that HRT in fact increases the risk of cardiovascular disease in this group. Controversy now reigns over the use of HRT. With this in mind, should women be concerned about using oral contraceptives as they age?

Although cardiovascular risks in general increase as women get older, the contraceptive pills on the market today do not magnify them significantly, according to Andrew Kaunitz, assistant chair of obstetrics and gynecology at the University of Florida College of Medicine at Jacksonville. "For most reproductive-aged women, the pill is safe," he says.

The pill has also been suspected of increasing the risk of breast cancer, which also rises dramatically with age, and has been a concern with HRT. The latest studies do not support that conclusion either. "The overall picture with hormonal contraceptives is very reassuring," Kaunitz says.

Best of all, the pill offers significant health benefits that increase with age. For each year a woman spends on the pill, her risk of ovarian cancer drops by 5 percent; long-term users see reductions in risk of up to 80 percent, according to Kaunitz. Endometrial (uterine) cancer risk is reduced by 40 percent with short-term use (under five years) and even more for long-term users. Colon cancer risk also declines, and the pill improves bone health, which may decrease the chance of osteoporosis.

"If I developed a pill for men that reduced prostate cancer risk that significantly, I'd get the Nobel Prize," Kaunitz says. He notes that taking the pill until menopause can relieve menopausal symptoms as well—and when a woman believes her natural periods have stopped, she can switch to hormone replacement if symptoms occur. Kaunitz and many other physicians believe that the studies showing increased risks of heart attack and stroke from HRT are flawed because they looked at elderly women whose use of HRT began years after the onset of menopause, not during menopause, when the therapy is usually prescribed.

Jennifer Blake, chief of obstetrics and gynecology at Sunnybrook and Women's College Hospital in Toronto, notes that using the pill or other highly effective contraception as menopause approaches is especially important for those who want to avoid pregnancy. The abortion rate for women over 40 is second only to that for those under 24. "Older women are at a higher risk for taking chances," she says, because they think they're infertile.

The Bottom Line: Using the pill if you're over 40 is safe, and has several surprising health benefits.