Birth control pills are one of the most popular contraceptive choices for women of all ages; however, the risks of oral contraceptives do increase somewhat after 35. Choosing the right pill can help to reduce those risks, as can lifestyle changes. Women through age 40 may even find that oral contraceptives reduce the discomforts and inconvenience of perimenopause.
Monophasic Combination Pills
Monophasic combination pills rely upon a low dose of both estrogen and progesterone. The hormone level in the pills is consistent throughout the pill pack. Typically, 21 days of pills are taken, then seven days of a placebo or spacer pill. Modern options, like Seasonale, Seasonique and Lybrel, allow women to take pills back to back without placebos, thereby avoiding periods. A low-dose pill will typically have fewer side effects, including a lower risk of stroke, high blood pressure or blood clots. A very-low dose pill, like Alesse or LoEstrin, is especially important for women over 35 who wish to continue taking the pill.
Biphasic and Triphasic Pills
These combination birth control pills work much like a monophasic pill, but the hormone levels vary during the course of the cycle. Some women may have less breakthrough bleeding on a pill with a varying dose. These pills do include a higher dose of estrogen than the lowest dose monophasic pills, but Mircette and Cyclessa can be good choices for women over 35 who experience fewer side effects on a biphasic or triphasic pill. All combination pills should be avoided by smokers over 35 or those who are at high risk for stroke or blood clots.
The progesterone-only mini-pills, including Micronor, Nor-QD and Ovrette, offer an estrogen-free alternative that is acceptable for women through 40. Estrogen is responsible for the increased risk of blood clots and strokes on the pill, so women at higher risk of these conditions, including smokers, may choose to take a progesterone-only pill. The mini pill is not as effective as combination pills and must be taken at the same time each day precisely to prevent pregnancy. Breakthrough bleeding and irregular periods are common with progesterone-only pills.