Advice about Birth Control

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Birth control after 45

December 2004

I have been feeling the old urge, but for a long time have not been satisfied with birth control methods. At 45+ years of age, I am wondering how careful I have to be? My husband will only have intercourse w/orgasm if he knows I'm on the pill, but I have been trying various levels of hormone and ALWAYS have breakthrough bleeding, sometimes for two weeks! When I upped the level of hormones I had both breakthrough bleeding and bloat and weight gain. Argh. My husband insists that he's satisfied with other forms of sex (oral, manual, pulling out during intercourse), but I have to say that I'm addicted to intercourse up to and including orgasm for both of us. With variations, to be sure... Anyway, I've tried diaphragms (gave me bladder infections), creams (yick), condoms (mate doesn't like 'em)... Help me out here, ladies and gentlemen. My husband won't go for the snip-snip, by the way, and I am not interested in forcing him. Can I perform without a net at my age? stymied

The answer is a cervical cap -- a wonderful device which is has many of the advantages of the pill (you can be spontaneous) with none of the chemical side effects. Cervical caps can be inserted up to 24 hours before intercourse, you do not need to reapply contraceptive substance, and you can leave it in for up to (I think) 24 hours afterwards. It's not as large and intrusive as a diaphragm, and does not cause bladder infections the way a diaphragm can. Not sure where you can get one these days, but they are a great solution that millions of European women use.
If you're using the ''pull out during intercourse method'' you're already ''performing without a net.'' There are lots of sperm present before orgasm. That's how I got pregnant at age 21.
happily post menopausal now
What about an IUD? I have had one for a year, and I love it. I am 40. anon
Yeah, sure, have sex without birth control -- if you want to be a mom again at 45.... (sounds like a lot of work to me, and your kid would have a real high risk of being born with Downs or other genetic problems, but hey....) If you're still menstruating, you can still get pregnant. If you are really averse to both barrier and hormonal methods, you might look into Natural Family Planning, which is very effective but also a considerable committment of time and energy (you have to be taught how to do it,and then you have to apply the methods Every Single Day without screwing up....)
The highest rate of unintended pregnancy after teens is in women over 45! I'm a family planning nurse practitioner and know a lot about all the methods and a lot about the consequences of not using them. Have you considered an IUD? They are extremely safe, extremely effective, and extremely convenient. There are 2 IUDs available, one with and one without hormones, they are effective for at least 7 years, and it takes 5 minutes to put one in. I'd be happy to email with you separately if you have concerns.
If you're still having regular periods, or even irregular periods, there is still a chance that you could get pregnant. You could have your doctor check you FSH level, but even if it were high (which means you're moving towards menopause) the level can vary from day to day, so it's no guarantee. There are two other birth control methods that are less available, but very effective when used properly. The cervical cap is like a small diaphragm that creates a seal with your cervix, so sperm can't get through. It's not as large or awkward as a diaphragm, and doesn't have the same risk of urinary tract infections because it doesn't usually put pressure on the urethra. A newer form of birth control is called the Fem cap, which is kind of like a cervical cap except it's made of polyurethane (not latex) and is much easier to fit. You can find practitioners who are trained in fitting these at I believe that most planned parenthoods fit for both devices. Tara
The snip-snip is so simple it's ridiculous. I can't understand anyone's refusal to take this option, given all the downsides to the alternatives -- it just seems selfish. I didn't give it a moment's thought (I'm 45 and had it done four years ago). Perhaps your husband just doesn't have enough information and is scared by what he doesn't know. Suggest to him that he at least look into it -- read up on the procedure, talk to others, including a doctor. I don't think you want to force him (whatever that would mean) or make him feel guilty, but he owes it to the both of you to at least make a good faith effort to look into it. This is not your problem or responsibility alone.
I'm 40, finished with childbearing, and I love my copper IUD! No hormones, no bloat, no acne, no daily pill -- really, no birth control worries for the next 10 years. The only side effect was that my periods were extremely heavy for the first 6 months after I got the IUD put in, and I had to wear double tampons AND pads for a few days each month. To my mind, it was well worth it. IUDs are very safe these days ... the Dalkon Shield gave 'em a bad name, but the technology has changed. Talk to your gyno. And I definitely would not assume that you can go without birth control at 45 ... that sounds like leaving the door open to a surprise pregnancy, unless you had a very early menopause.
No more pills!
My husband and I use condoms. Not the optimal way, but they work. My husband also would not get a vasectomy. I'm done with diaphragms (did them most of my single pre-baby life), not interested in the pill, so condoms seem to be it, other then abstinance, which at my age is not a bad idea!! There are condoms made from animal skin so they are more natural feeling than latex. They're a bit pricey but really do make a difference in ''energy exchange'' of skin to skin. You can certainly have great ''other'' sex, ie: not intercourse, and not have to worry about b.c., but why have to make that a rule. Your husband won't get a vasectomy and doesn't like the way condoms feel! hmmmmm....somethings gotta give here!! Good luck. anon
Have you considered an IUD? I had one put in last year and I LOVE it. I have gone from (preIUD) 5-7 days of heavy flo to 2 days of spotting a month. (I got the Mirena IUD. I understand that the Copper T IUD is supposed to make flow heavier... though my friend loves hers.) My husband and I are quite pleased as we don't have to worry about condoms, and all of the bad side effects I was having with the pill (my bp was starting to get on the high side) have disappeared. It can remain in place for years so you won't have to worry about it for a long time.
pg worry free.
A Mirena would be a good choice, especially if you've already had children. It's a small, soft IUD that slowly releases small doses of the hormones found in the Pill, but because they go right to the target, you get less systemic side effects. It lasts five years, and is even more effective at preventing pregnancy than the Pill.
No more kids for me
Use birth control unless you would consider a pregnancy and/or abortion. I have two friends who were already diagnosed as infertile couples and adopted children five or more years ago, and both found themselves giving birth for the first time in 2004 at the age of 45. You could try tracking your fertility cycles and work around them (see ''Taking charge of your fertility'' by toni Weschler), but keep in mind that as you approach menopause your cycles will fool you in an apparent attempt to get nature to run its course.
I have been happy with my iud, tho you'll have to determine if it is the right thing for you. I had it inserted when I was 40 (am now 45) and like the idea that it will last for 10 years, and I likely will be post-menopausal at that point. I have seen plenty of 45 and 48 year old mothers at my prenatal clinic, so I wouldn't count on lowered fertility, based on age alone. Another thought might be to do some kind of fertility awareness, where you track when you are fertile. Then you will have part of the month when you don't need birth control, and part of the month when you can do other stuff...
Be careful! I got pregnant at about your age because a did not have any contraception in place after the birth of my third child. Since then, I've had an IUD inserted and am very pleased with it: I never think about contraception, do not feel anything and have sexe without any worry. It's worth it.
I'm in my late 40s and my husband and I have been using a system for the last few years that (so far) is working well. I have very regular periods, so I reckon ovulation is most likely very regular too, on day 14, probably. On the tenth day of my cycle (the tenth day from when my period started) I start using a diaphragm with spermicidal jelly for the next ten days. I'm also not overly fussed about leaving it in for 8 hours. I will do so if asleep, otherwise if I'm up and about 4-6 hours I estimate probably does the trick. The other 18 days of my cycle we use nothing. Works for us and the sex is great. Of course, this is a gamble, but I'm counting on that regular period, and the fact that my fertility is likely very low by now. Good luck on whatever you decide.
middle aged woman who also loves sex
Read Taking Chargeof Your Fertility. Toni Welcher. It can really educate you about your body and when you are ovulating so you can know if it is safe or not to have unprotected sex
Try the nuvaring. It offers the same protection as the pill with fewer side effects. You can read all about it here: I highly recommend it. However, it is a little pricey depending on your health insurance plan. Kaiser will cover it if you get your doctor to write it as an exception. If you have to buy it out of pocket I think it runs around 42.00/month from Longs.