Women should still use contraception until 1 year after the last menstrual period because irregular ovulation may occur. 

Since well-designed studies proved an increased risk of thromboembolism with aging and with estrogen   dose, it   is   wise   to   prescribe   the   lowest   available   dose   of ethinylestradiol (EE)  in   the   COCs   for   adequately   counselled   couples ⁽¹⁶⁾.

Furthermore, women’s age, obesity and family history of hypertension were associated with an increase of blood pressure and this event resulted independent of the contraceptive used. ⁽¹⁷⁾.

Besides, the low affinity to androgen receptors of some progestins could influence the endogenous androgen environment in the direction of hypoandrogenism ^(3,18).

A lot of studies suggest that the androgens play an important role in modulating the female sexual arousal.

In addition, beginning in their 30s, women slowly lose circulating testosterone and significant associations between low sexual responsiveness and age are reported.

It is necessary to make an accurate selection of the middle aged women considering the high risk of adverse effects of this age-group.

Generally, disturbances –COC related, are mild or moderate in level ; rarely,severe and only sporadic fatal cases are reported.  Whatever the case,  severe adverse effects exist;  perhaps they are very   rare,  but   it   might   be   that   other   cases   were   underestimated   or ignored ^(19,20,21).

Therefore,also mild or moderate adverse effects of COCs may impact the woman’s quality of life.

Particularly, considering the modern lifestyle, more importance is devoted to loss of desire caused by some COCs and their capability to heavily influence the relational and intimate life ⁽¹⁸⁾.

Besides, even small increases in frequency of adverse effects in COCs -users have a general critical health impact because of their widespread use,  which is currently expanding   to   potential   risk   groups   ⁽²²⁾.  In   fact,  women   transplanted, depressed, suffering cardiovascular diseases,  diabetes,  neoplasms, thrombophilic syndromes   or   rare   diseases   and/or   smokers,  today   seek   contraception ⁽²³⁾.