Contraception during perimenopause and menopause

The likelihood of pregnancy depends on how many eggs you have left and how often you are having sex, but pregnancy can still occur during the perimenopause, and when you’re on HRT.

So, when can you safely stop using contraception?

Actually, there is very little scientific evidence to go by. The Faculty of Sexual and Reproductive Health (FSRH) has guidelines that healthcare professionals can refer to. This claims that between the ages of 40 and 50, you can stop using contraception if you have not had a period for two years. Over 50 years old, you can stop contraception after not having a period for one year. (The term ‘period’ here means a natural period, not a withdrawal bleed while on hormone treatment.)

In general, all women can stop using contraception at the age of 55, even if they are still having some periods. After the age of 55, pregnancy is exceptionally uncommon.

In some situations, a follicle stimulating hormone (FSH) blood level can be checked in women over 50 years old to assess the likelihood of pregnancy. Although an FSH level would not be helpful if you are taking certain hormonal treatments e.g. HRT and the combined pill.

The type of contraception you use is a joint decision between you and your doctor. It’s important to weigh up the pros and cons, risks and benefits of each choice as well as your personal preferences.

Here are some of your options:

• Barrier methods (like the male or female condom and diaphragm) are generally very effective. If they fail, usually it’s because of a problem while using them, like a condom splitting.
• The copper coil is very effective at preventing pregnancy. The coil is placed into the womb through the cervix (which sits at the top of the vagina). If this is put in after the age of 40, it can stay in until the menopause.
• There are several progesterone only contraceptives. The ‘mini pill’ contains a low dose progestogen and is very effective if taken correctly. Often it leads to lighter periods or no periods, but some women experience some spotting between periods. This is safe to take until the age of 55.
• The progestogen implant is a small plastic rod placed under the skin of the arm. It lasts for 3 years and is safe to continue using until you’re 55.
• The progestogen injection lasts for 8-13 weeks, depending on which type you have. If you are 50 or over you should have a chat with your doctor about whether it’s still the best contraception for you because with increasing age, other health issues which come into play have to be considered, particularly bone health which can be affected by this injection.
• An IUS is a coil inserted into the womb which releases progestogen over a period of years. The Mirena coil can remain in the womb until the menopause if inserted at or after the age of 45. The Mirena can also be used as part of HRT, but in this case would need to be changed every 5 years to keep the lining of the womb thin.
• The combined contraceptive pill contains oestrogen and progestogen. It is not recommended to be used if you are over the age of 50 (or if you are younger and have an increased risk of clots or heart disease). It’s a very effective contraception and can help alleviate some symptoms of the menopause. One downside is that it can reduce your libido.
• There are also surgical options. Men can have a vasectomy and women a sterilisation, which is where the fallopian tubes are blocked or sealed to stop eggs reaching sperm.

If you’d like to discuss your contraception options, book a consultation with one of the Menopause Care specialists.