# Hormonal Contraception After 35 and Its Risks ## Introduction Many women continue using hormonal
The topic of contraception is one that women discuss throughout their lives – and yet the conversation changes significantly with each decade. What worked at twenty may not be the ideal choice after thirty-five. The body changes, health risks shift, and life priorities are often completely different. Yet many women continue using hormonal contraception almost automatically, without taking the time to reflect with their doctor on whether it is still the best path for them.
This is not a question of fear or rejection of modern medicine. It is a question of being informed. Hormonal contraception after the age of 35 carries specific risks that practically do not exist at a younger age – and at the same time, there are a whole range of alternatives worth knowing about.
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What changes in the body after thirty-five
Thirty-five is something of an imaginary milestone in gynaecology. It is not an arbitrary boundary – it is supported by research. After this age, the risk of cardiovascular disease, blood clots, migraines, and certain types of tumours naturally increases. And it is precisely these factors that come into play when a doctor assesses whether combined hormonal contraception – that is, the kind containing both oestrogen and progestogen – is suitable for a particular woman.
The World Health Organization (WHO) has issued detailed recommendations for the use of contraceptive methods, the so-called Medical Eligibility Criteria for Contraceptive Use, which clearly describe in which health conditions and life situations certain methods are unsuitable or risky. Combined hormonal contraception falls into a category where age alone does not yet mean an automatic prohibition – but in combination with other factors, it may be a decisive argument for change.
Among these factors, smoking is particularly notable. A woman over 35 who smokes should not use combined hormonal contraception at all – the risk of thrombosis and stroke is too high in such a case. Similarly, increased caution applies to women with hypertension, migraine with aura, diabetes with complications, elevated cholesterol levels, or a family history of cardiovascular disease. This is not theoretical scaremongering – these are real health consequences documented by studies published, for example, in the British Medical Journal.
At the same time, it is important to say that many women over thirty-five do not have these risk factors, live healthily, and combined contraception may continue to be a safe choice for them. The key phrase, however, is "individual assessment" – and truly individual at that, not merely a routine prescription renewal once a year.
Consider Martina, a forty-year-old accountant from Brno who had been taking the combined pill since she was eighteen. She has never smoked, exercises regularly, and is not overweight. Nevertheless, her gynaecologist suggested during a preventive check-up that they discuss alternatives together – not because the pill was dangerous, but because Martina had entered an age when natural hormonal changes begin to manifest and when it makes sense to consider whether synthetic hormones still match her needs. Martina's body is changing and she has the right to know what options she has.
Hormonal contraception after 35: risks that cannot be ignored
One of the most widely discussed topics is the relationship between hormonal contraception and the risk of thromboembolic disease. Oestrogen increases blood coagulability, which is negligible in young women without additional risk factors, but the situation changes with age, sedentary work, possible long-haul flights, or surgical procedures. Research repeatedly confirms that the absolute risk remains low, but the relative increase compared to women not using hormonal contraception is statistically significant.
Another topic is the effect on mood and mental health. Many women over thirty-five report feeling "different" after stopping the pill – calmer, more alive, more like themselves. Research published in JAMA Psychiatry demonstrated a link between hormonal contraception and an increased risk of depression, with this effect being more pronounced in adolescent girls but also present in older women. The aim is not to cause panic, but to ensure that women have the complete picture.
We must not overlook the effect on libido either. Combined contraception lowers testosterone levels, which can lead to a decrease in sexual desire. For women in middle age who are already dealing with natural hormonal fluctuations, this effect may be more pronounced than in youth. And even though it is still rarely discussed, this is a matter of quality of life – and that matters.
As British gynaecologist and author of Perimenopause Power, Maisie Hill, put it aptly: "Many women don't even know how they truly feel without synthetic hormones, because they've been taking them since puberty." This thought is not a call to stop contraception overnight, but an invitation to reflect: what does my body actually need right now?
When to consider alternatives and what options are available
Switching to a different contraceptive method is not a failure or a concession – it is a sensible response to the changing needs of the body. Alternatives to hormonal contraception are far more varied today than they were twenty years ago, and they are worth knowing about.
The intrauterine device (IUD) in its hormonal version – the best known being Mirena – releases only locally acting progestogen and contains no oestrogen. For many women over thirty-five, this represents an excellent compromise: reliable protection, minimal systemic hormonal impact, and additionally a beneficial effect on heavy menstrual bleeding, which is common at this age. The copper intrauterine device, meanwhile, works with no hormones at all – it is a purely mechanical method with high reliability.
The progestogen-only "mini-pill" is another option for women who prefer oral contraception but wish to avoid oestrogen. It contains no oestrogen, and is therefore also suitable for smokers or women with migraine with aura – groups for whom the combined pill is contraindicated.
Barrier methods – condoms, cervical caps, or diaphragms – have been experiencing a renaissance in recent years, not only as protection against sexually transmitted infections. For women in long-term relationships where the risk of STIs is low and where the natural end of the fertile years is approaching, these methods may be entirely sufficient.
It is also worth mentioning fertility awareness methods (FAM), which combine measuring basal body temperature, monitoring cervical mucus, and optionally using digital tools. Modern apps such as Natural Cycles, which received FDA certification as a contraceptive method, bring a scientific basis to this approach. However, it should be said openly: these methods require discipline, regularity, and are less reliable than hormonal or intrauterine methods – especially for women with irregular cycles.
For women who are certain they no longer wish to have children, sterilisation – tubal ligation – is a permanent and highly reliable option. Equally, a partner's vasectomy is a safe, straightforward, and in a long-term relationship, very practical step.
When it comes to natural approaches to supporting hormonal balance, an increasing number of women are turning to dietary supplements, adaptogens, or products supporting the natural hormonal cycle. These are not a substitute for contraception, but they may help the body manage the transition into perimenopause more smoothly and alleviate possible mood fluctuations or irregular cycles. Such products for natural health and hormonal wellbeing can be found, for example, in the range offered by the online shop Ferwer, which specialises in natural and ecological products for a healthy lifestyle.
How to have the conversation with your doctor
The way the topic of alternatives is raised at all plays a significant role. Many women admit they are afraid of being "brushed off" by their doctor or of not being taken seriously. Yet quality gynaecological care includes precisely this discussion – and a woman has the right to initiate it.
Before visiting the doctor, it is worth clarifying a few things: Do I have any risk factors (smoking, hypertension, migraine with aura, family history of thrombosis)? Am I satisfied with how I feel on the pill – physically and psychologically? Am I still planning a pregnancy, or not? How important to me is the simplicity of the method versus minimal interference with my natural cycle?
These questions are not academic – they are the fundamental building blocks of an informed decision. And it is precisely an informed decision that should be the starting point of every contraceptive choice – regardless of age, but all the more so after thirty-five, when the body enters a new phase of its natural development.
For many women, their forties are a time when they truly ask for the first time what their body needs – not what is most convenient or what has worked since their twenties. And that is actually a great starting point. Transitioning to a different contraceptive method can be the first step towards a deeper understanding of one's own body and towards self-care that goes beyond routine medical appointments. At a time when we have access to information, expert recommendations, and natural alternatives, there is no reason to remain with options that have stopped serving us.
