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Original site: www.cdc.gov/contraception/hcp/usspr/contraception-not-needed.html | RestoredCDC.org is an independent project, not affiliated with CDC or any federal entity. Visit CDC.gov for free official information. Due to archival on January 6, 2025, recent outbreak data is unavailable. Videos are not restored. Access data.restoredcdc.org for restored data. Use of this site implies acceptance of this disclaimer.
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Contraception
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CDC Contraceptive Guidance for Health Care Providers U.S. MEC, 2024 U.S. SPR, 2024 U.S. MEC and U.S. SPR Provider Tools View All
November 19, 2024
When Contraceptive Protection Is No Longer Needed
Summary for U.S. SPR, 2024 |
Page 17 of 26 | All pages
At a glance
This page includes recommendations for health care providers that address when contraceptive protection is no longer needed. This information comes from the 2024 U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR).
When contraceptive protection is no longer needed
* Contraceptive protection is still needed for patients aged >44 years who want to avoid becoming pregnant.
Comments and Evidence Summary
The age at which a person is no longer at risk for becoming pregnant is not known. Although uncommon, spontaneous pregnancies occur among persons aged >44 years. Both the American College of Obstetricians and Gynecologists and the North American Menopause Society recommend that women continue contraceptive use until menopause or age 50–55 years.[382],[383] The median age of menopause is approximately 51 years in North America[382] but can vary from 40 to 60 years.[384] The median age of definitive loss of natural fertility is 41 years but can range up to 51 years.[385],[386] No reliable laboratory tests are available to confirm definitive loss of fertility in a woman; the assessment of follicle-stimulating hormone levels to determine when a woman is no longer fertile might not be accurate.[382]
Health care providers should consider the risks for becoming pregnant in a patient of advanced reproductive age, as well as any risks of continuing contraception until menopause. Pregnancies among women of advanced reproductive age are at higher risk for maternal complications (e.g., hemorrhage, venous thromboembolism, and death) and fetal complications (e.g., spontaneous abortion, stillbirth, and congenital anomalies).[387-389] Risks associated with continuing contraception, in particular risks for acute cardiovascular events (venous thromboembolism, myocardial infarction, or stroke) or breast cancer, also are important to consider. U.S. MEC states that on the basis of age alone, patients of any age can use (U.S. MEC 1) or generally can use (U.S. MEC 2) IUDs and hormonal contraception.[1] However, patients of advanced reproductive age might have chronic conditions or other risk factors that might render use of hormonal contraceptive methods unsafe; U.S. MEC might be helpful in guiding the safe use of contraceptives in these patients.[1]
In two studies, the incidence of venous thromboembolism was higher among oral contraceptive users aged 45–49 years compared with younger oral contraceptive users;[390-392] however, an interaction between hormonal contraception and increased age compared with baseline risk was not demonstrated or was not examined.[390],[391] The relative risk for myocardial infarction was higher among all oral contraceptive users than among nonusers, although a trend of increased relative risk with increasing age was not demonstrated.[393],[394] No studies were found regarding the risk for stroke in combined oral contraceptive (COC) users aged 45–49 years (Level of evidence: II-2, good to poor, direct).
A pooled analysis by the Collaborative Group on Hormonal Factors and Breast Cancer in 1996 found small increased relative risks for breast cancer among women aged ≥45 years whose last use of combined hormonal contraceptives (CHCs) was <5 years previously and for those whose last use of CHCs was 5–9 years previously.[395] Seven more recent studies suggested small but nonsignificant increased relative risks for breast carcinoma in situ or breast cancer among women who had used oral contraceptives or depot medroxyprogesterone acetate (DMPA) when they were aged ≥40 years compared with those who had never used either method[396-402] (Level of evidence: II-2, fair, direct).
Related PagesU.S. SPR, 2024
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* U.S. SPR, 2024
* Emergency Contraception
* Permanent Contraception
*
* Conclusion
* References
*
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Conclusion
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Table of Contents |
Summary for U.S. SPR, 2024
* Table of Contents
* Introduction
* Summary of Changes from the 2016 U.S. SPR
* Methods
* Keeping Guidance Up to Date
* How To Use This Document
* How To Be Reasonably Certain that a Patient Is Not Pregnant
* Testosterone Use and Risk for Pregnancy
* Intrauterine Contraception
* Implants
* Injectables
* Combined Hormonal Contraceptives
* Progestin-Only Pills
* Standard Days Method
* Emergency Contraception
* Permanent Contraception
* When Contraceptive Protection Is No Longer Needed
* Conclusion
* References
* Appendix A
* Appendix B
* Appendix C
* Appendix D
* Appendix E
* Appendix F
* Acknowledgments, Contributors, and Participants
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November 18, 2024
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP); Division of Reproductive Health
Related PagesU.S. SPR, 2024
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* U.S. SPR, 2024
* Emergency Contraception
* Permanent Contraception
*
* Conclusion
* References
*
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Contraception
There are safe and highly effective methods of contraception available to prevent or reduce the chances of unintended pregnancy. CDC provides clinical guidance to assist health care providers in counseling women, men, and couples about contraceptive method choice. They also offer clinical guidance to reduce medical barriers to contraception access and use.
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