What are the risks of birth control for older women?
This question not only applies to pills but also birth control patches and vaginal rings, since they all are based on the same hormonal treatment approach: they all raise estrogen and progestin levels in the woman’s body. They only differ in how they deliver the hormones, i.e., orally, through the skin, and through the vagina.
It’s also important to remember that birth control isn’t just taken to prevent pregnancies, even though that’s the main application. Birth control meds can help women manage menstruation irregularities and treat polycystic ovarian syndrome. Therefore, it’s not uncommon that some women take birth control drugs until they reach their menopause.
Birth control pills on their own don’t pose any threat to “older” women — the age threshold typically used in the context of birth control in the medical literature is 35 — but they can worsen certain medical conditions that occur with increasing age. The big concern here is blood clotting (thrombosis), a disorder that disrupts the body’s blood circulation and in consequence, can yield a wide range of adverse outcomes. The risk of thrombosis goes up with age, sharply so after 45. Using birth control pills further increases the risk.
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Birth control won’t raise the risk much for girls and younger women, who don’t have a high thrombosis risk to start with. But it can make a difference for women aged 35 and older. If, in addition to being aged >35, a woman is a heavy smoker and/or overweight, the thrombosis risks are compounded further.
Therefore, if you are older than 35 and believe you have a reason to regularly take birth control pills, carefully discuss with your doctor to fully understand the associated risks. You may want to consider taking progestin-only pills, as they have fewer side effects.
What are some other safety concerns over long-term birth control use?
As you just read, with increasing age there’s an increased risk of birth control pills exacerbating the risk of blood clotting. There’s also the risk that long-term pill use may raise your breast and cervical cancer risk. The scientific evidence for the latter is not entirely clear, but according to the American Cancer Society, it’s likely. That said, these risks decrease again once a woman discontinues the pill.
On the upside, long-term pill use appears to reduce the risk of other cancers: a 2018 study
of 100,000 women between 50 and 71 found that long-term birth control use lowered the risk of getting ovarian and endometrial cancer. This probably because women on birth control ovulate less than it’d normally be the case.
Practice Committee of the American Society for Reproductive Medicine. “Combined Hormonal Contraception and the Risk of Venous Thromboembolism: A Guideline.” Fertility and Sterility, vol. 107, no. 1, 1 Jan. 2017, pp. 43–51, www.ncbi.nlm.nih.gov/pubmed/27793376, 10.1016/j.fertnstert.2016.09.027. Accessed 15 Mar. 2020.
Girolami, A., et al. “Effect of Age on Oral Contraceptive-Induced Venous Thrombosis.” Clinical and Applied Thrombosis/Hemostasis, vol. 10, no. 3, July 2004, pp. 259–263, 10.1177/107602960401000308. Accessed 13 May 2019.