01 Mar 2010
While age is one consideration, individual preferences and other factors such as the presence of medical conditions also inf luence the appropriate method of contraception for each woman. No matter which age group a woman belongs to, a comprehensive discussion with a family doctor or gynaecologist will help identify the best choice of contraception for her.
The 20s:
The peak of fertility
A woman’s fertility peaks in her mid-20s and effective contraception at this age is essential as many women often favour chasing career or personal goals over starting a family. The combined oral contraceptive (COC) – better known as the pill – is a clear favourite. COCs are easily reversible and women often start ovulating within two months of going off the pill. Also, modern versions contain only a fraction of the hormone dose contained in the original pill and have fewer side effects.
COCs contain a mix of oestrogen and progesterone and act by preventing ovulation. They are typically taken for 21 days in a month followed by a seven-day break – a pillfree interval – during which a menstrual period will occur.
Non-contraceptive benefits include lighter, less painful periods and a reduced incidence of oily skin and acne. Taking two or more packets consecutively without allowing for the usual pill-free interval will delay the menstrual period, which is useful when having a period is inconvenient.
The combined use of a barrier method such as a condom and COCs is known as the “Double Dutch”, which provides additional effectiveness as a contraceptive and reduces the risk of contracting a sexually transmitted infection such as HIV.
Much is often said of the risk of cancer. While it’s true that there is an increase in breast cancer incidence following five years of pill use, this increase is small and amounts to one additional case of breast cancer per year in 1,000 women who have been on the pill. This risk diminishes quickly to normal once oral contraception is discontinued.
The 30s:
Longer-term contraception preferred
Women in their 30s often look for longer-term contraception because they want to space out their pregnancies or have already completed their families. With longer-term methods, women won’t have to remember to take a pill or use a condom.
The two most popular methods at Singapore General Hospital are a progesterone-hormone-containing intrauterine device (also called an intrauterine systemor Mirena) and a progesterone-containing implant which is inserted under the skin of the arm (Implanon). Mirena and Implanon have very low failure rates.
A side effect of any progesteronereleasing contraceptive method is light but often irregular bleeding, which is more apparent when the method is first used. Bleeding often settles with time.
In the longer term, these methods may cause an absence of periods, which is not harmful and will be corrected once either method is discontinued.
Mirena is also very effective for heavy periods as it reduces menstrual blood loss by up to 80 per cent. Evidence has shown that using Mirena has reduced the need to have a hysterectomy (removal of the womb) for heavy periods. Implanon, on the other hand, is an effective treatment for dysmenorrhoea (painful periods).
Mirena and Implanon are effective for five and three years respectively, but they can be removed at any time, with fertility rapidly restored. Other methods include the older copper intrauterine device (IUCD) and an injectable three-monthly progesterone hormone called Depo-Provera. Unlike Mirena, the copper IUCD causes periods to become slightly heavier. Light, irregular bleeding is also common with Depo-Provera injections.
The 40s:
Health concerns and waning fertility
In many respects, the contraceptive needs of women in their 40s are no different from those in their 30s. Two differences are worth noting, however. First, some women develop illnesses such as diabetes and high blood pressure in their 40s, which increase the risk of heart disease and stroke. The progesterone-only pill or “mini pill” contains only one hormone (progesterone instead of oestrogen and progesterone, which is found in the COC) and does not carry the risk of heart disease, stroke or breast cancer.
Although less effective than the COC and not widely available in Singapore, the mini pill is often sufficiently effective in women in their 40s. This underscores the second difference. Seemingly less effective methods may provide good contraception in this age group due to the group’s reduced natural fertility. (For example, the copper IUCD should normally be changed every five years. However, if it is inserted after the age of 40, it can be used until menopause without requiring a further change.)
Finally, women of any age who have completed their families sometimes choose permanent methods such as sterilisation. This usually involves laparoscopic (keyhole) surgery in which a small metal clip is used to block the fallopian tubes. While effective, the method does still carry a small risk of failure – and subsequent pregnancy. Male sterilisation or vasectomy is a safer procedure as it does not involve entering the abdomen and has a lower failure rate. Unfortunately,
this method is not popular here.
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