Fertility gradually declines beyond the age of 40, but pregnancy is still possible, even as periods become less predictable. Studies indicate that 26.9% of pregnancies in women aged 40 and older are unintended, highlighting the continued need for contraception for those who wish to avoid pregnancy. For most women, it’s recommended to use contraception until the age of 50 or until 12 months after their last menstrual period to prevent pregnancy.(1)
Contraception during perimenopause not only helps prevent unintended pregnancies but can also offer additional benefits, such as managing heavy bleeding and stabilizing hormonal fluctuations. This article explores why contraception remains important during perimenopause and provides practical guidance on the safest and most effective options for women navigating this stage of life.
Understanding Menopause and Birth Control
Menopause marks the natural end of a woman’s reproductive years, defined as 12 consecutive months without a menstrual period. Contraception is no longer necessary after menopause, as ovulation ceases entirely, making pregnancy biologically impossible.(2)
Once a woman has completed menopause, ovarian function comes to a halt, which means eggs are no longer released, eliminating the possibility of conception. Additionally, the hormonal changes during menopause bring a significant decline in estrogen and progesterone levels, creating an environment where fertilization cannot occur. Fertility naturally decreases in the years leading up to menopause, with a steep decline after the age of 40. By the time menopause is completed at age 50–51 on average, the chances of pregnancy are effectively zero.(2)
Continuing contraception beyond menopause offers no benefits and may pose unnecessary health risks, particularly with hormonal options like combined oral contraceptives, which can increase the risk of cardiovascular complications, such as blood clots and stroke.
If there’s uncertainty about menopausal status due to ongoing hormonal treatments or irregular cycles, consulting a healthcare provider can help provide clarity and guide the next steps.
Use of Birth Control During Perimenopause
During the transition to menopause, known as perimenopause, the risk of unintended pregnancy still exists. Ovulation may occur sporadically, even with irregular periods, making contraception an important consideration for women in this phase of life.
For women under 50, experts advise contraception until age 50 or 2 years have passed without a cycle to ensure the prevention of pregnancy, unless another method of permanent pregnancy prevention is in place, such as a hysterectomy..
On the other hand, women over 50 are advised to stop the use of contraceptives, as the chance of pregnancy is effectively zero. However, consulting a physician is crucial to determine whether contraception is still necessary.
Benefits and Risks of Birth Control During Perimenopause
Contraceptives are effective for preventing unintended pregnancy during perimenopause while also offering additional benefits. However, they are not without risks. Striking a balance between these factors is essential for making informed choices.
Some benefits of using birth control during perimenopause include the following:
Preventing unwanted pregnancy
Regulating menstrual cycles
Improving mood stability
Treating symptoms of gynecological conditions, such as polycystic ovary syndrome (PCOS), endometriosis, or pelvic pain
Supporting bone density and overall health
Protecting against certain cancers, such as ovarian and endometrial cancers
The risks of birth control can vary depending on the individual and the type of contraception used, with potential concerns like the following:
Increased risk of cardiovascular issues and stroke with hormone-based contraceptives, especially for those with conditions like hypertension, obesity, or a history of smoking
Allergic reactions and urinary tract infections with barrier methods
Given the diverse benefits and risks, personalized guidance from a healthcare provider is critical. Factors such as medical history, lifestyle, and patient preference can influence the choice of contraception. This individualized approach ensures women receive both effective protection and symptom relief tailored to their unique needs.
Best Contraception Methods for Women Over 40
Choosing the right contraceptive method after 40 involves considering individual preferences, health conditions, and lifestyle. While many options are available, each comes with its own set of benefits and drawbacks.(3)(4)(5)
Hormonal Options
These are some of the common hormonal contraceptive options:
Birth Control Pills
Pros: They can help regulate menstrual cycles and reduce heavy bleeding. Some formulations may protect against ovarian and endometrial cancer.
Cons: Birth control pills may increase the risk of blood clots, stroke, or heart disease, particularly in individuals with a history of smoking or certain health conditions like hypertension.
Birth Control Injections
Pros: Birth control injections provide longer-lasting protection, with injections required only every 3 months. They are highly effective and may also protect against ovarian cancer.
Cons: They can cause irregular bleeding or amenorrhea (the absence of menstruation).
Hormonal Intrauterine Devices (IUDs) and Implants (Long-Acting Reversible Contraceptives)
Pros: These methods are long-acting and low maintenance, remaining effective for 3–7 years. They may also reduce heavy bleeding and cramps.
Cons: Placement requires a minor procedure performed by a medical professional, and removal also requires an in-office procedure.
Non-Hormonal Methods
Non-hormonal options are ideal for women who prefer to avoid hormones or have contraindications to hormonal use.
Barrier Methods (e.g., Condoms, Cervical Cap, Diaphragms, Birth Control Sponge)
Pros: Barrier methods contain no hormones, are easy to use, and provide immediate protection. Condoms also protect against sexually transmitted infections (STIs).
Cons: They require consistent and correct use, and some people may find them inconvenient.
Copper IUD
Pros: The copper IUD is long-acting (effective for up to 10 years), hormone-free, and highly effective at preventing pregnancy.
Cons: It can initially cause heavier periods and cramping. Placement also requires a procedure performed by a medical professional in the office.
Spermicide and Contraceptive Gels
Pros: They are hormone-free, widely available, and easy to use.
Cons: These methods are less effective when used alone and may cause irritation. They should be used in combination with condoms, a contraceptive sponge, or a diaphragm to be more effective.
Individualized Approach
The best contraceptive method depends on a woman’s overall health, risk factors, and reproductive goals. For instance, women with a history of blood clots may be advised to avoid estrogen-containing methods, while those seeking long-term options may prefer an IUD. Consulting with a healthcare provider is essential to weigh the pros and cons of each method and make an informed decision.
Transitioning Off Birth Control
As women approach menopause, transitioning off birth control becomes an important milestone. Choosing the right contraception during this phase is critical for ensuring safety, effective symptom management, and overall well-being.
As discussed above, experts suggest women should remain on contraception until age 50 as a precaution against unintended pregnancy.
For most women over 50, contraception is generally not necessary, as the likelihood of pregnancy becomes negligible. However, for those who still need contraception due to irregular cycles or specific health concerns, safer options like intrauterine devices (IUDs) or non-hormonal methods are preferred.(1)
Progestin-releasing IUDs, for example, can prevent pregnancy and also help manage heavy menstrual bleeding, which can be a concern for some women during perimenopause. For women experiencing significant bleeding, an ablation procedure may be an alternative to contraception. Ablation reduces or eliminates heavy menstrual bleeding and provides a long-term solution without the need for hormonal intervention.(1)(3)
Monitoring Menopause Symptoms
After stopping birth control, it’s essential to monitor one’s health. This period is associated with an increased risk of conditions such as osteoporosis, heart disease, and urogenital atrophy. Regular check-ups with a healthcare provider can help monitor and manage these risks effectively, ensuring the transition to menopause is as smooth as possible.
Considering HRT
For managing the broader range of menopausal symptoms, including hot flashes, night sweats, vaginal dryness, and bone density concerns, HRT is often the preferred option. HRT provides a tailored approach to replenishing declining hormone levels, offering relief from symptoms and supporting long-term health. Unlike contraception, HRT is not designed to prevent pregnancy but instead focuses on improving quality of life during and after menopause.(1)
