Birth Control Pills for Women Over 35

Older versions of birth control pills contained high doses of estrogen, making these types of prescriptions risky for women over the age of 35. Yet, advancements in medicine have made a wider range of hormonal birth control pills safe for women aged 35 and above.

Nowadays, most birth control pills contain lower doses of estrogen and other hormones, making them safe for use after age 35. However, if you possess certain risk factors — like high blood pressure or a smoking habit — estrogen-containing pills may not be the best birth control method for you.

This article discusses the safety of birth control pills for women over the age of 35, including important health and lifestyle-related risk factors to be aware of.  

Are birth control pills safe for women over 35? 

In general, most low-dose birth control pills available today are considered safe for women over 35. 

Many of the conceptions regarding the safety of birth control for women over 35 were associated with older versions of birth control that contained high doses (35 mg or more) of estrogen. Today, most conventional birth control pills contain between 10 to 30 mg of estrogen.  

However, certain risk factors — like high blood pressure or a history of blood clots — can make birth control pills a riskier option for women who are 35 or older.  

Additionally, the Heart and Stroke Foundation of Canada states that estrogen-containing birth control pills may present a higher risk for women over the age of 35 who are also obese and/or a smoker. 

Birth control pill risks for women over 35 

When it comes to the risks of birth control pills for women over 35, it often depends on how many overlapping risk factors a woman has.  

For instance, a woman in a healthy weight range who doesn’t smoke and is not already at risk for heart-related conditions can take conventional birth control pills without immense risk. 

If a woman has one lifestyle-related risk factor, such as obesity or a smoking habit, the risk of health issues when taking birth control after the age of 35 heightens. In this case, a healthcare practitioner may recommend a low-dose estrogen-containing birth control or progestin-only birth control.  

When these lifestyle-related risks are paired with certain health conditions — like high blood pressure — the risk is heightened further. Women with pre-existing health conditions (which we discuss more in the next section) will generally not be recommended to take estrogen-containing birth control, regardless of lifestyle habits.  

Additionally, once women surpass the age of 35, healthcare practitioners begin considering their risk of developing heart-related conditions.  

Research regarding the relational risks of estrogen-containing birth control and age is largely outdated, though some older studies have stated that oral contraceptives can be a safe and effective form of birth control in women over 35 who do not have other risk factors.  

Health-related risk factors of birth control pills to consider 

As discussed, some of the biggest risk factors when it comes to taking birth control pills over the age of 35 are pre-existing health conditions or pre-existing risks for developing certain conditions. 

These health-related risk factors include: 

High blood pressure  

High blood pressure — also called hypertension — is a condition in which a person’s blood pressure levels remain consistently high throughout the day.  

Blood pressure is measured using two numbers:

1. Systolic pressure: Systolic blood pressure is the pressure that occurs as the heart contracts when pushing blood through a person’s blood vessels (arteries).  

2. Diastolic pressure: Diastolic blood pressure is the pressure that occurs as the heart relaxes between beats.

The official measurements that qualify as hypertension in Canada are as follows:

• For the average person (when measured by a healthcare practitioner): 140mmHg or higher for systolic, 90 mmHg or higher for diastolic 
• For the average person (when self-measured at home): 135mmHg or higher for systolic, 85mmHg or higher for diastolic 
• For people with diabetes or chronic kidney disease: 130mmHg or higher for systolic, 80mmHg or higher for diastolic 

As far as how high blood pressure relates to birth control risks, research on the relationship between oral contraceptives and hypertension suggests that high-dose estrogen pills are correlated with the development of hypertension. 

Though the occurrence of this health condition as a result of birth control use is rare, it is an important consideration for women over 35, as people above this age are generally considered to be at higher risk for developing hypertension.  

Smoking  

While smoking tobacco/nicotine products is a lifestyle habit, it can also present moderate to serious consequences for a person’s health.  

Smoking is associated with the development of several health conditions, including:

• Heart disease  
• Stroke 
• Plaque build up in the arteries 
• Blood clots  

Additionally, the Heart and Stroke Foundation of Canada states that smokers are two times more likely to experience heart attacks or strokes, as well as two times more likely to die from them. Furthermore, people who smoke 25 or more cigarettes daily are three times more likely to experience a heart attack or stroke and roughly five times more likely to die from them.  

Occasional use of tobacco products is not necessarily considered to put a person at greater risk of such conditions. However, it is important to note that nicotine-containing products are highly addictive, leading to overuse and misuse.  

In terms of how this relates to birth control since both overuse of tobacco/nicotine and high doses of estrogen are associated with the development of heart-related problems, the presence of both in a person’s day-to-day life can heighten the risk of heart-related conditions even further.   

Blood clots  

Blood clots are masses of blood that stick together and can block blood flow through a person’s arteries. Excessive occurrence of blood clots can potentially lead to a stroke or heart attack.  

Estrogen-containing birth control can increase the occurrence of blood clots in all women. 

Additional risk factors for blood clots include:

• Pregnancy  
• Post-pregnancy for the first six weeks following delivery 
• Family history of blood clots 
• Obesity 
• Surgery or injury (blood clots can naturally form as a means to stop bleeding)

Despite the risk of blood clots, many healthcare practitioners still recommend using birth control pills, as the risk of blood clots developing is higher during pregnancy. 

Moreover, research suggests that the risk of blood clots is the highest for birth control pills that contain drospirenone — making this specific type of birth control one to avoid for women at risk of blood clot development.  

Diabetes 

Many of the risks of diabetes as related to birth control have more to do with a heightened risk during pregnancy.  

Effective birth control is often regarded as a preventative measure to help avoid risky pregnancies — though hormonal birth control methods may not be the best choice for women with specific diabetes complications.  

For many women who have diabetes, one 2016 study states that effective contraception is necessary to prevent uncontrolled glucose levels that can occur as part of an unplanned pregnancy and are recommended to use non-hormonal birth control methods, such as copper intrauterine devices (IUDs). 

The Diabetes Canada Clinical Practice Guidelines Expert Committee recommends that women with type 1 or type 2 diabetes receive ongoing healthcare counselling regarding the use of birth control, especially regarding how it relates to glycemic control before pregnancy.  

Migraines with aura 

Migraines are a severe form of headache that causes throbbing and/or pulsing pain, as well as other symptoms such as nausea, vomiting, and light sensitivity. 

An additional and rarer symptom associated with migraines is aura. Aura is defined as visual disturbances, such as coloured spots or blurred vision. In addition to visual symptoms, aura is also associated with a tingling sensation and difficulty speaking.  

Women who experience migraine with aura are considered to be roughly twice as likely to experience a stroke as those who experience migraines without aura.

As we have covered, estrogen-containing birth control pills are associated with a higher risk of developing heart-related conditions, such as stroke. 

The actual relationship between migraines and birth control is considered very unpredictable, as migraines can be triggered by hormonal fluctuations.  

For some women, continuous use of birth control can lessen the chances of migraines, as their hormones are kept at more stable, consistent levels. However, for others, changes to hormonal levels due to birth control can boost the occurrence of migraines. 

This association between hormonal fluctuations and migraine occurrence is seen primarily with estrogen-containing birth control pills. Migraine Canada states that alternatives such as progestin-only birth control pills or non-hormonal IUDs are considered generally safe for women who experience migraines with aura.  

Other methods of birth control to consider 

Although women over the age of 35 who have certain risk factors may not be well-suited for an estrogen-containing birth control prescription, many alternative forms of birth control exist that are safe for use. 

These include: 

The mini-pill 

The mini-pill is a progestin-only birth control pill that does not contain estrogen.  

This form of oral contraceptive is considered to have the same effectiveness as estrogen-containing birth control — 91% with typical use and 99.7% with perfect use. Additionally, the mini-pill works in the same way as estrogen-containing birth control by:

• Inhibiting the release of an egg from the ovary 
• Thickening of the cervical mucus to prevent sperm from reaching an egg 
• Thinning of the uterus lining to prevent the implantation of an egg  

The mini-pill is a commonly used alternative for women over the age of 35 who have additional risk factors, such as a smoking habit.  

Rings and patches  

Hormonal rings and patches are generally considered safe forms of birth control for women over 35, though these products do contain both estrogen and progesterone.  

Most birth control risks for women over the age of 35 result from a high dose of estrogen. Rings and patches typically contain a low dose of estrogen, making them safe to use for most women. 

Always consult with your healthcare practitioner regarding the safety of hormonal birth control methods in relation to your specific health needs.  

Non-hormonal birth control methods  

For women over the age of 35 who are not compatible with hormonal birth control methods, a variety of non-hormonal birth control methods can be effective means of contraception. 

These include: 

• Non-hormonal IUDs: Non-hormonal IUDs are a t-shaped device with copper wire wrapped around them. They are inserted into the vagina and can be kept in place for between 5 to 10 years. The effectiveness of this type of IUD is 99.1%, with both typical and perfect use.  
• Condoms: Condoms are a barrier method of contraception that does not contain hormones. They come in both male and female versions — the male version is worn on an erect penis, and the female version is fit inside the vagina. Condoms have the added advantage of protecting against STDs. 
• Cervical caps and diaphragms: Cervical caps and diaphragms are forms of barrier methods. They are made from silicone and come in the shape of a thimble or dome. To use these, you must self-insert them into the vagina and use them in tandem with spermicide. These methods of contraception have varying degrees of effectiveness, as they are easy to place incorrectly.  

Tubal ligation 

Tubal ligation is a surgical procedure that closes a person’s fallopian tubes, commonly referred to as having your “tubes tied.” 

When tubal ligation is performed, the fallopian tubes are closed via banding, cauterizing, tying and cutting, or clipping. Sometimes, a healthcare practitioner may offer to perform a full hysterectomy (removal of the uterus) if certain health risks are identified (primarily cancer).  

A salpingectomy — a procedure in which one or both of the fallopian tubes are removed — is becoming an increasingly offered option in Canada, as it can also help reduce the risk of ovarian cancer. 

Although tubal ligation is a highly effective surgery for preventing pregnancy, there are some rare cases in which the tubs can regrow roughly a year after the surgery takes place. This happens to approximately 5 out of every 1,000 women.  

Should you stop taking birth control after 35?  

After you have turned 35 or older, you do not necessarily need to stop taking your birth control pills. 

However, it is important to discuss your health with your healthcare practitioner once you turn 35.

If you have any pre-existing or newly developed conditions — or if you have a family history of certain conditions like blood clots or diabetes — your healthcare practitioner may advise switching to a low-dose, progestin-only, or non-hormonal birth control method.  

Key Takeaways 

For many women, it is safe to continue taking birth control pills after they turn 35 or older.  

In some cases, certain health conditions, lifestyle habits, or other risk factors may make a person incompatible with estrogen-containing birth control after age 35. 

The best way to determine what birth control method is right for you is to speak with your healthcare practitioner.  

To discuss what birth control options may be right for you, get started with Felix today.