Reproductive Health and Women with Rare Coagulation Disorders

Treating Menorrhagia (continued)

Q: What is your opinion on using the birth control pill after the age of 35? (Some gynecologists recommend going off oral contraceptives at that age.)

• If you recommend going off them, what do you recommend in their place?

• If you recommend staying on them, at what age do you recommend women stop taking them?

Judy Simms-Cendan, MD

There are NO contraindications to using combined oral contraceptives with estrogen after the age of 35, as long as the woman does not smoke, or have other reasons to increase her risk of venous thromboembolism (blood clots), such as obesity, hypertension or diabetes. For women with bleeding disorders, this risk is very low. In general, we know the risk of venous thromboembolism is proportional to the estrogen in the birth control pills. Higher estrogen leads to higher risk. After age 35 we try to use less estrogen because the older we get, the more likely we are to have atherosclerosis in our blood vessels which increases the risk of blood clots. In general, the pills we choose have 10-20 micrograms of ethinyl estradiol, the lowest dose pills.

Ian Bishop, MD

Age itself should not be a contraindication to combined hormonal contraception (pill, patch, ring). These methods can be continued until the age of menopause in healthy, non-smoking, normal weight women – and may be especially helpful for women using combined hormonal contraception to manage heavy or irregular menses. However, there may be other comorbidities (such as smoking, hypertension, etc) that might make us think about discontinuing earlier. To mitigate the risk of thrombosis for women over age 35 who desire combined hormonal contraception, I usually put them on a pill that has 20mcg estrogen – this would be considered a “low dose” pill.