Contraception in the latter part of reproductive life.

Contraception in the latter part of reproductive life is particularly important because of the increased fetal and maternal mortality associated with pregnancy in this age group. The combined pill can be continued until the menopause in healthy, non-smoking women with no additional risk. The advantages of the combined pill include protection against menopausal symptoms as well as some of the common gynecological disorders. Progestogen-only formulations can now be administered by both oral and non-oral routes. The levonorgestrel-releasing IUD is an exciting new development, especially suited to this age group because of the reduction in menstrual loss. Although barrier methods often prove unacceptable if used for the first time in the late thirties and forties, they have no serious adverse effects and in addition provide protection against cervical intraepithelial neoplasia and sexually transmitted disease.