Contraception can be an important consideration for women aged 50 years and older who have not reached menopause, as unintended pregnancies at this stage of reproductive life can be medically and socially challenging. Determining whether contraception is required and actively informing patients of their options with respect to methods, contraindications, risks and benefits, will help GPs support women in this age group to make an informed choice that best suits their personal circumstances and preferences.
Contraception remains important in avoiding unintended pregnancy until menopause can be established, that is, until a woman has had two years of amenorrhoea if she is under the age of 50 years, or at least one year of amenorrhoea since turning 50. Although pregnancy in women aged 50 years or over is very uncommon and background fertility is low, unintended pregnancies can be problematic at this later stage of reproductive life.1 There is a high rate of miscarriage and fetal abnormality, as well as higher risks of background morbidity that can impact the outcome of a pregnancy.2 Available data indicate that around 16% of pregnancies in women aged 45 years or over end in abortion.3 It is important that GPs actively inform their perimenopausal patients about the risk of pregnancy as women in this age group may underestimate their fertility and be unaware of the need to use contraception. The role of the GP is to determine patient preferences and take a relevant medical and social history in order to provide balanced information on safe and suitable options.