Nursing Care of the Postmenopausal Woman, 3rd Edition
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Table 1-5. U.S. Medical Eligibility Criteria for Contraceptive Use Type of Contraceptive Low-dose Progestin- only pill Etonogestrel implant Copper Intra-
Depot medroxy- progesterone acetate injection
Levonorgestrel intrauterine device
(<35 mcg) oral contraceptive, patch, ring if no smoking
uterine device
Discontinue Age (years)
50
> 50
>50
>55
One year after amenor- rhea
55
Risk Category 2 1 1 = A condition for which there is no restriction for the use of the contraceptive method. 2 = A condition for which the advantages of using the method generally outweigh the theoretical or proven risks. 3 = A condition for which the theoretical or proven risks usually outweigh the advantages of using the method. 1 2 1 1 4 = A condition that represents an unacceptable health risk if the contraceptive method is used. The table above represents the only risk factor being age. It does not take into account any other health risks. Note : Adapted from Curtis, K. M., Tepper, N. K., Jatlaoui, T. C., Berry-Bibee, E., Horton, L. G., Zapata, L. B., . . . Whiteman, M. K. (2020). U.S. Medical Eligibility Criteria for Contraceptive Use. Morbidity and Mortality Weekly Report, 65( 3), 1-104.
Options available for women over age 40 who still need contraception include: ● The copper intrauterine device . This IUD is licensed for up to 10–12 years of use and can be inserted at age 40 or older and remain until the woman has remained amenorrheic for greater than one year (FSRH Clinical Effectiveness Unit, 2019). ● Levonorgestrel intrauterine device . This IUD has levonorgestrel within its system and works as progesterone protection as part of hormone combination therapy. This IUD must be replaced every 8 years. It is not approved for use after age 65 (Bayer Healthcare, 2022). ● Progestogen-only injectable . Women over age 40 may use this method but should be advised regularly to assess
the risks for bone loss (FSRH Clinical Effectiveness Unit, 2019). ● Oral progestogen-only pills (POP) . Women may continue this type of contraceptive pill until they reach age 55, when contraception can be stopped. POP has been known to cause irregular bleeding, which may be a nuisance for the women, but it is not associated with the cardiovascular risks of combined hormonal contraception (FSRH Clinical Effectiveness Unit, 2019). ● Oral combined hormonal contraception. Combined oral contraception (COC) containing levonorgestrel or norethisterone and <30 µg ethinyl estradiol can be considered for women over age 40. This combination of medication has a lower cardiovascular risk profile than other combinations. Women over age
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