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Getting the right advice on contraception in the perimenopause is important as the risks and benefits of different forms of contraception change as you enter your 40s. Here is an overview of contraception and the menopause transition, how our fertility changes as we age, and the different methods of contraception.
Contraception does not affect the timing or duration of menopause, but it may mask the symptoms that indicate the start of menopause transition. This is because many women do not have periods when using some types of contraception. Other types of contraception give a regular ‘artificial’ bleed. You are therefore unable to use your bleeding pattern ‘know where you are’ in the menopause transition, or whether your periods have stopped.
Some methods of contraception may actually help you to manage symptoms – for example, progesterone-only contraception can help manage heavy and irregular bleeding of the perimenopause, and the combined oral contraceptive pill contains an oestrogen that may help manage hot flushes and other symptoms.
Fertility decreases as you get older (starting around the mid-30s), and it drops significantly as you approach the menopause. However, your fertility doesn’t decrease to zero in the perimenopause – some women get pregnant naturally in their late 40s and even in their 50s – so it’s important to use contraception if you don’t want to get pregnant.
Pregnancy in your 40s and 50s can be more complicated. The risk of miscarriage and ectopic pregnancy increases with age, as do pregnancy and birth complications. Discussing your plans with a healthcare professional may be helpful if you’re trying to conceive.
You can read more about fertility in menopause here.
The different types of contraception fall into categories of:
This form of contraception can be used alongside hormone replacement therapy (HRT).
The copper coil, or intrauterine device (Cu-IUD) is a small T shaped copper-containing device that sits in the cavity of the womb. It lasts either 5 or 10 years depending on the type of fit. However, because fertility declines in your 40s, you can keep it for longer if it is fit at, or after, the age of 40. A Cu-IUD inserted at, or after, age 40 can remain in place until 1 year after the last menstrual period if it occurs when the woman is 50 years or older. If a woman is aged under 50, the Cu-IUD can remain in place for 2 years after the last menstrual period. They are fitted by specially trained doctors and nurses.
Male and female condoms prevent pregnancy by acting as a physical barrier to male sperm coming into contact with the female egg. They are made from very thin latex (rubber), polyisoprene or polyurethane. They are effective as a method of contraception if you use them correctly.
Progesterone only contraception can be used alongside hormone replacement therapy (HRT).
The progesterone-only pill (POP) is sometimes also known as the mini pill. It’s a tablet you take every single day. You can take the POP until the age of 55 – there are no specific age-related concerns.
The Mirena™ intrauterine system (IUS) is a small T shaped plastic device that releases a tiny amount of hormone – levonorgestrel. It sits in the cavity of the womb and is fit by specially trained doctors and nurses.
These are other intrauterine systems that also release tiny amounts of levonorgestrel. They are licenced for contraception only. Jaydess™ is licenced for 3 years for contraception, Kyleena™ is licenced for 5 years.
The progesterone-only contraceptive implant is a small flexible plastic-based rod that is fit by a doctor or nurse just beneath the surface of the skin in your upper arm. They provide effective contraception for up to 3 years.
The progestogen-only injectable contraception or ‘depot’ is a 3 monthly injection. You may be able to use this method of contraception up till the age of 50. However, if you are over 40 and you have risk factors for osteoporosis (thinning of the bones) – for example, you smoke, are underweight or have a medical condition which means you do not absorb nutrients well from your gut – the depot would not be the first choice for you. You should discuss this with a doctor if it applies to you.
You can’t take CHC alongside HRT.
The combined hormonal contraceptive (CHC) pill or patch is the only method of contraception to contain an oestrogen and a progestogen. There are health risks associated with this specific method of contraception, so if you are aged 50 and over and still taking CHC, it is advised that you stop and switch to a safer alternative. If you are 40 and taking CHC, you will need a discussion with a doctor to make sure that it is safe for you to continue to use CHC in your 40s.
You can stop using contraception if you are over the age of 50, and your periods have naturally stopped for more than 12 consecutive months (that is, you are through the menopause and are now postmenopausal). This advice applies only if you are not taking hormones or using the hormone intrauterine system.
If you are between 40 and 50, you can stop using contraception if you have been postmenopausal for 2 years (i.e. your periods have stopped naturally for 24 consecutive months). Again, this advice applies only if you are not taking hormones or using the hormone intrauterine system.
At the age of 55, you can stop using contraception even if you’re still bleeding.
If you are not bleeding because you are using a progestogen only hormone contraception (such as the progesterone-only ‘mini pill,’ the Nexplanon™ implant, the depot injection or the Mirena™ intrauterine system), an FSH (follicle stimulating hormone) blood test can be useful in helping you work out when to stop using contraception. Speak to a doctor to arrange this, and for advice on how to interpret the results.
Dr Clare Spencer
Registered menopause specialist, GP and co-founder
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Faculty of Sexual & Reproductive Healthcare. Contraception for women aged over 40 years. FSRH, 2017. Available at: https://www.fsrh.org/standards-and-guidance/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/
Trussell J. Contraceptive failure in the United States. Contraception. 2011 May;83(5):397-404. Available at: https://bedbible.com/how-often-do-condoms-break-statistics/