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Hormonal Contraception in Women of Older Reproductive Age

Andrew M. Kaunitz, M.D.

A healthy, lean 46-year-old woman who is a nonsmoker requests advice about contraception. She notes that her menstrual periods are less regular than previously, and she also reports intermittent bothersome hot flashes. She is in a new relationship after a divorce, and she is sexually active. She asks if she can begin to use an oral contraceptive. What would you advise?

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Funding and Disclosures

Dr. Kaunitz reports receiving consulting fees or lecture fees and grant support (to the University of Florida Research Foundation) from Bayer, Barr Pharmaceuticals, Johnson & Johnson, Organon, and Warner Chilcott. No other potential conflict of interest relevant to this article was reported.

An audio version of this article is available at www.nejm.org.

I thank Karen Koppel Kaunitz, Esq., for invaluable editorial support with an earlier version of the manuscript.

Author Affiliations

From the Department of Obstetrics and Gynecology, University of Florida College of Medicine–Jacksonville, Jacksonville.

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