What are the current guidelines for providing hormonal contraception to women older than 50 who have no medical contraindications?
—Susan Kilburn, RN-C, APN, Henderson, Nev.

Perimenopausal women who have no risk factors are still good candidates for monophasic, low-dose oral contraceptives. For women who may be experiencing heavier bleeding or who have fibroids causing heavy bleeding, a levonorgestrel-releasing intrauterine system (Mirena) is a good choice. This method will not only reduce bleeding but gradually shrink the fibroids as well. When prescribing Mirena or medroxyprogesterone (Depo-Provera), the long-term effect on bone density should be considered, especially in this older population.
—Sherril Sego, MSN, FNP (114-5)

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