Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 10/15/2020
Hormonal birth control pills are a safe, highly effective way to prevent pregnancy and reduce your period symptoms. However, just like other forms of contraception, it’s important that you stay aware of their risks as you get older.
For women under 40, birth control pills are generally safe, with few lasting side effects.
However, as you enter your early 40s, your risk of experiencing adverse effects from the pill increases.
Below, we’ve explained how the safety of birth control changes as you enter your 40s and 50s, as well as what you can do to safely keep yourself protected from becoming pregnant if you’re 40 and older.
For the most part, birth control pills are extremely safe. Serious side effects are rare from both combined and progestin-only contraceptives. Your risk of experiencing a blood clot or stroke is also extremely low, especially if you’re otherwise healthy.
However, your risk of experiencing a cardiovascular side effect from birth control does increase as you get older. It’s still an extremely small risk, but the possibility of a blood clot happening is higher than it was in your past.
In a 2013 study of women over 40 years of age who used birth control, researchers found that women who use estrogen-based birth control (such as combined birth control pills) are about twice as likely as non-users to experience a blood clot in the arm, leg or groin.
Despite this, blood clots and other cardiovascular side effects from birth control are still very rare, even for women aged 40 and up. In the same study, the rate increased from four to five blood clots per 10,000 women, to eight to 10 per 10,000 in hormonal birth control users aged 40 and up.
However, it’s important to note that you shouldn’t use birth control after the age of 40 if you smoke cigarettes. Smokers aged 35 and up have the highest risk of blood clots from hormonal birth control and should only use an alternative form of contraception.
Our guide to birth control and smoking goes into more detail on the dangers of using hormonal birth control if you’re a smoker, as well as what you can do to keep yourself protected if you use cigarettes or other tobacco products.
These days, there’s no age limit for using hormonal birth control, meaning your healthcare provider will usually look at your medical history and current health to determine what your best course of treatment is.
Most of the concern about women 40 years old and older using birth control dates back to the ‘60s and ‘70s, when birth control pills contained higher quantities of estrogen and were more likely to cause cardiovascular issues.
Modern birth control pills generally contain smaller quantities of hormones, meaning that many of the older warnings and recommendations have been changed to better reflect the current — generally less serious (but still noteworthy) — risks and side effects of taking these pills.
If you have existing health conditions that make the pill unsafe, your healthcare provider might recommend an alternative form of birth control. Many women aged 35 and up with health issues that make the pill unsafe are able to use other forms of contraception, such as an IUD or implant.
Your healthcare provider might also recommend using a progestin-only birth control pill. These pills do not contain any estrogen and only use a low dose of a progestin hormone, which may make them less likely to cause cardiovascular side effects.
We’ve explained these in more detail below, as well as several other safe, effective methods of birth control that you can use in your 40’s and fifties.=
As you learned when you first started using birth control, there really is no one best birth control option for women in their 40s and fifties.
The best thing to do is contact your healthcare provider to discuss your potential health risks, other medications you might be using, your medical history, etc., and work with them to determine the best option for you.
That said, here are a few options your healthcare provider may recommend:
The progestin-only birth control pill. Progestin-only birth control pills have a lower risk of causing cardiovascular side effects such as blood clots, meaning they could be the best option for you if you’d like to continue using birth control in your forties.
While progestin-only birth control pills are just as effective at stopping pregnancy as combined birth control, it’s important to know that they do not treat hormonal acne or other health issues that are targeted by combined birth control pills.
The IUD. Intrauterine devices (IUDs) are less likely to cause blood clots than combination birth control pills, making them an alternative form of birth control if you’re concerned about cardiovascular issues.
Our comparison of IUDs and the pill goes into more detail on how the hormonal IUD works, as well as how hormonal IUDs compare to combined and progestin-only birth control.
The birth control implant. Like progestin-only birth control and the IUD, the birth control implant only contains a small amount of progestin hormones, giving it a lower risk of causing blood clots and other cardiovascular side effects.
Non-hormonal or barrier method birth control. Birth control options that don’t contain any hormones, such as a diaphragm or condoms, are not linked to any increase in your blood clotting risk.
Using birth control in your 40s doesn’t need to be a stressful or physically dangerous experience. Below, we’ve listed a variety of options that you can use to keep your birth control usage safe and minimize your risk of experiencing any unwanted side effects:
Get checked up regularly. It’s best to schedule a checkup with your healthcare provider at least once a year as you enter your 40s and fifties. Not only does this help you reduce any risks from birth control, but it’s also a great way to stay on top of other health issues.
If you smoke, try to quit. Smokers have by far the biggest health risks from hormonal birth control. If you’re approaching or over the age of 35 and want to continue using the pill, the best way to keep yourself healthy is to quit smoking.
Maintain a healthy weight. Obesity is a major risk factor for deep vein thrombosis and other blood clotting issues. Maintaining a healthy weight in the normal BMI range is one of the best ways to reduce your blood clot risk while using hormonal birth control.
Stay active. Regular exercise, especially cardiovascular exercise, can help reduce your risk of experiencing a blood clot. Even a short walk in the morning can be enough to get your blood flowing and encourage healthy circulation.
If you’re in good health and have no existing conditions that could increase your risk of blood clots, it’s usually safe to continue using birth control as you enter your forties.
However, if you smoke or have any preexisting conditions that increase your likelihood of experiencing blood clotting, it’s usually best to explore alternative birth control options that don’t affect your cardiovascular health.
As always, the best approach is to talk to your healthcare provider. From scheduling regular check-ups, to recommending an alternative form of birth control, your gynecologist or healthcare provider will help you stay protected from pregnancy while minimizing your overall health risks.
Want to learn more about birth control and your health? Our guide to birth control side effects goes into more detail on how some forms of birth control can affect your clotting risk, as well as what you can do to stay healthy while using hormonal birth control.