The 40s are often deemed the decade of freedom. Careers are stable, and relationships are solid (for the most part). You are done with babies or opted to not go this route (and for those still on the baby journey keep this advice for later!). You are a seasoned player on almost all fronts. But just because your brain thinks pregnancy is a thing of the past doesn’t mean that your ovaries are in agreement. Despite a decrease in egg quality and quantity, you can get pregnant in your 40s, so much to your chagrin, you can’t throw your birth control out when you hit 43, 45, or even 48. As long as you are still ovulating, you can get pregnant, no matter how old you are!
The reality is that, although your body is changing, your birth control options are not much different as you move throughout the decades. No matter what age you are, the name of the game for hormonal contraception is preventing ovulation, fertilization, and implantation. While certain options might work better at certain points in your life, they will all work in preventing pregnancy. For example, we are big fans of the hormonal IUDs (Mirena, Skyla, Liletta) for women in their 40s. They not only prevent pregnancies but also do so with little systemic exposure to hormones (a.k.a. the hormones stay in the uterus rather than in other areas of the body). This reduces the risk of negative side effects from hormones. It also reduces the risk of select cancers such as uterine cancer, a malignancy that affects women as they age.
On the flip side, while oral contraceptives may have been your go to in your 20s, they may not be right for you in your 40s. Women above the age of 35 are more likely to suffer the negative side effects from oral contraceptive pills. This is because age plus issues like high blood pressure, obesity, diabetes, and high cholesterol/triglyceride levels (disease processes that are more likely to be present as we age) equal a greater chance of bad things (stroke, blood clot, etc.) happening while on oral contraceptive pills. So while oral contraceptive pills are not totally out, a good history and physical exam are required before starting them.
The bottom line is that you can’t just assume that your baby-making days have passed you by, even if you used fertility treatments to conceive or if everyone around you is using fertility treatments to get pregnant. While age is a risk factor for infertility, not every woman in her 40s is infertile. Until your periods bid you adieu, you can’t break up with your birth control. This is one relationship you can’t seem to get rid of! While your ovaries may be running on empty, they still have some gas left in the tank. And although we all love surprises, this surprise may be one that will make you do a whole lot more than scream!