The IUD is an excellent choice for contraception in older women in mutually monogamous relationships. Currently, in the United States, there are two IUDs available. The ParaGard is sometimes associated with significant dysmenorrhea, although this can often be controlled with nonsteroidal anti-inflammatory agents. The Progestasert is a T-shaped UID with a reservoir in the vertical stem containing 38 mg of progesterone. This IUD is associated with decreased menstrual flow, but must be changed on an annual basis.
Effectiveness is increased if the barrier method is combined with spermacide.
For barrier methods to be effective they must be used consistently. The failure rate in this age group is much less than in younger age, likely due to a combination of increase compliance and cycle fecundity. Condoms should always be advised for protection against sexually transmitted diseases for women not in mutually monogamous relationships. There are now many contraceptive options available to the woman of advanced reproductive years. These options should be discussed to find the method most appropriate for each woman.