Is there a preferred contraceptive method for a woman older than age 50 years still having her period? — Connie Kelly, FNP, Franklin, N.Y.

The risk of a pregnancy is extremely low in such a woman. Nevertheless, birth control should be continued until menopause is confirmed (clinically defined as one year of no menses in a woman of menopausal age). A 50-year-old woman who is otherwise healthy should be counseled on all birth-control options, but I would guide her away from such invasive and long-term methods as an intrauterine device or Essure, as she is likely on the verge of menopause. If she is interested in oral contraception (OC), there are many low-dose options, including a pill containing only 10 mg of ethinyl estradiol (although there is no contraindication to using a 20 mg pill in this population).

Since OCs can mask menopause, the question is when to stop taking the pill. Some clinicians wait for menopausal symptoms to appear during the hormone-free week, after which the woman can stop OCs and see how her cycle responds. Another option is to periodically check follicle-stimulating hormone (FSH) level. If her FSH is >20 mIU/mL, most clinicians would feel confident taking her off OCs, as the risk of pregnancy is virtually nil. — Mary Newberry, CNM, MSN (163-3)

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