Is it good to avoid oral contraceptive pills after 40 years?

Q. Why should we avoid oral contraceptive pills after 40 years?

Answered by
Dr. Rishu Sharma
and medically reviewed by Dr. K Shobana
This is a premium question & answer published on Dec 08, 2016 and last reviewed on: Jun 02, 2023

Hello doctor,

I have a question. Estrogen shows cardioprotective effect before menopause. But, it increases the risk of CVS diseases if taken in oral contraceptive pills. And, they say that oral contraceptive pills should be avoided after 40 years because of CVS complications. I am not getting it. If it is cardioprotective, then why cannot it be given after 40 when estrogen levels in the body decrease? Also, I wanted to know, whether these side effects of oral contraceptive pills are dose dependent. Because, normally in young women estrogen is cardioprotective, but if given extra from the outside, it is increased in the body than required and so, it cause complications. Is this true? Please explain.



Welcome to

Natural estrogen is cardioprotective as it increases the level of HDL (high-density lipoprotein) and decreases the level of LDL (low-density lipoprotein). Oxidation of LDL cholesterol is believed to be the initiator of atherosclerosis. Estradiol and other estrogens are believed to inhibit this process. Hormone replacement therapy - HRT rapidly increases the level of C-reactive proteins in the body, a marker of inflammation associated with increased risk of cardiovascular disease. Recently, two major studies found that HRT inpostmenopausal women increases the risk of breast cancer. Another study proved that HRT in postmenopausal women increases the risk of cardiac events and thrombosis. Hence, women should be advised to cease therapy postmenopause. However, a detailed analysis showed that the time of initiating HRT postmenopause plays a crucial role. When initiated within five years of menopause in a healthy woman estrogen-based HRT has far more benefits than adverse outcomes. The pros of HRT includes reduces symptoms of menopause, reduce osteoporosis dementia and colon cancer, and improves cardiovascular system. The cons of HRT are doubles the risk of thromboembolism and doubles the risk of breast cancer. So, pros and cons are to be evaluated before initiating HRT in postmenopausal women.

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