Times have changed and the dosages of birth control pills (BCP) have come way down. When BCPs first came out, we did not know how much hormone was needed, we just knew we did not want pregnancies. The first BCPs were mega-dose pills, with up to 10 times the dose of hormone that is used in today's pills.

Since those early days, we have brought the dose of estrogen in the pill lower and lower, to the point at which they are now, using the lowest possible doses that suppresses ovulation. This has made the pill much safer. Many of the known complications of using BCPs are related to the higher dose pills and the early studies done with them. Now, with the lower dose pills, there is more break through bleeding, but much less of the life threatening problems of stroke, heart attack and clots forming in leg veins.

We Ob-Gyns, in the past, have not allowed patients over 35 to use BCPs, but recent evidence appears to say that the risks of this are no higher than in younger women, provided they are not smokers. Smoking injures blood vessels, making these life-threatening problems much more likely (even if you don't take the pill).

There are also, now, very, very low dose pills that are being used in women over forty. The dosages in these pills are not much higher than the common doses of hormone replacement we give women in their menopause. Blood pressure, diabetes and cholesterol are followed more closely in the older pill taker but, doing this, BCPs may be an option into the forties.

I still advise a tubal ligation be done once a woman is sure she will never want another pregnancy. This still avoids the cost and hassle of ten years of taking a daily medication.




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