Menopause Contraception to Prevent Pregnancy & STIs | Stella
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Menopause and contraception: your questions answered

byDr Lucy Wilkinson

With all the focus on hot flushes and HRT, contraception is often overlooked around the time of menopause, yet it’s really important to prevent an unplanned pregnancy. It may be rare but it can happen! Plus if you have a new partner or partners you’ll need to carry on protecting yourself from potential STIs too. Find out everything you need to know about menopause and contraception from Dr Lucy Wilkinson.

Can you get pregnant during menopause?

Yes! Perimenopause and pregnancy can certainly go hand in hand. Although rare, natural pregnancies can happen well into your 50s, which might not be part of your life plan at this point. 

While it’s true that women are at their most fertile early in adult life, as long as your body is releasing eggs there is a chance of getting pregnant. Even if you have irregular or infrequent periods, there is still a chance that an egg has been released.

Women are often surprised when asked about contraception as part of a conversation about menopause, but it is still an important part of your healthcare. Pregnancies are riskier in older women, and we see increased rates of miscarriage, gestational diabetes and pre-eclampsia among other issues. Placental problems also become more common, as does having a baby with genetic problems (including Down’s syndrome).

Having said that, if you are nearing menopause and want to get pregnant then don’t leave it to chance! While it is possible to conceive at this time, it is unlikely without medical intervention. A fertility specialist will be able to explain your options. 

When can I stop using contraception in menopause?

You can wave goodbye to your contraception if you meet one of the following conditions:

  • You are postmenopausal. For the purposes of contraception, this means that at least one year should have passed since your last period if you are aged over 50, and two years if you are below 50. In both cases, this only applies if you aren’t on any hormonal medications as these can ‘mask’ the true pattern of your menstrual cycle
  • You are aged 55 or over 
  • You have had a hysterectomy

Otherwise, it’s likely that you need to continue using some method of birth control. If you have a new partner, it is always sensible to use condoms (or another barrier method) regardless of your menopausal status. This is to help prevent sexually transmitted infections.

How do you know if you’ve been through menopause?

The average age at menopause is 51 with some women going through menopause much earlier and others later.

Menopause is generally diagnosed based on your symptoms and bleeding pattern. If you are having typical menopause symptoms (including hot flushes), and you haven’t had a period in over a year, it is likely that you have gone through menopause. Read more about the stages of menopause here. 

Sometimes it can be more difficult to tell:

  • Some hormonal medications (including contraceptives like the mini pill) can cause periods to stop as a side effect
  • Periods can sometimes stop or become less frequent due to certain medical conditions. This means that you may not have been through menopause despite having been period-free for years.

Sounds confusing, right? This is the reason that it’s important to check in with your doctor before stopping contraception. They will be able to advise on the best options for your personal circumstances.

I’m on HRT. Do I still need contraception?

Yes. Although HRT contains the same hormones as many contraceptives, it does not work to prevent pregnancy in perimenopause and beyond. 

This is because higher levels of hormones are needed to act as contraceptives than those that are needed for HRT.

What is the best contraception for menopause?

The ideal contraception in menopause is the method that suits you and your body best!

As you approach menopause you may find that changes to your body, such as vaginal dryness, mean you need to swap your usual contraception for something more comfortable or appropriate for you.

Which non-hormonal contraceptives can you use during menopause?

These include:

  • Condoms 
  • An intrauterine device known as the copper coil. They are particularly useful if you want to avoid taking hormones, or you can’t take them for medical reasons

Condoms

Barrier methods, such as condoms, protect against sexually transmitted infections (STIs) but are not the most reliable contraceptive option. The failure rate is two pregnancies per 100 people per year if used perfectly.

Intrauterine device

The copper coil is a small device which sits inside the womb and works by releasing copper into the womb. This alters the cervical mucus and is toxic to sperm. In the unusual event that sperm makes it through and fertilizes an egg it is more difficult for a pregnancy to implant. 

The copper coil can be fitted by your doctor or at a family planning clinic. In younger women, these provide contraceptive cover for 5 or 10 years depending on the type fitted. If your coil is fitted over the age of 40, it provides contraception until you reach menopause. 

It is important to bear in mind that the copper coil can cause heavier periods. If this is already a problem for you (as it is for many women around the time of menopause), you may wish to consider an alternative option.

Read more about heavy periods during menopause.

Which hormonal contraceptives can you use during menopause?

A wide variety of hormonal contraceptives can be used during your menopause journey. Some of these have the added benefit of making your periods more regular or lighter, although they are not suitable for everyone.

Combined hormonal contraceptives

Combined hormonal contraceptives contain both oestrogen and progesterone and can be taken as pills, patches or vaginal rings.

While combined hormonal contraceptives are reliable and popular, they may not be the best choice as you get older. They are associated with:

  • Blood clots (including DVT and PE)
  • Cardiovascular disease
  • Breast cancer 

As your natural risk of these conditions increases with age, the same method that was safe in your 20s may no longer be ideal for use in your 40s.

Current guidance recommends that all women should stop combined hormonal contraception (including the combined pill) by the age of 50 for safety reasons.

If you are taking a combined pill in your 40s (or have other risk factors), your doctor may advise you to try switching the type of pill you take. Pills containing progesterone in the form of either levonorgestrel or norethisterone come with a lower risk of causing blood clots. Similarly, pills with a lower dose of oestrogen are also thought to minimise risks.

Progesterone-only contraceptives

Progesterone-only contraceptives tend to be much safer than those containing oestrogen, especially for women with certain risk factors or those over 50. Options include: 

The following points are important to note if you are approaching menopause:

  • The contraceptive injection can reduce bone density. As this naturally declines anyway over the course of your menopause journey, it is advisable to avoid the contraceptive injection after the age of 50 to prevent any additional thinning of the bones. If you are over 40 and still using the injection, your doctor will review you regularly to ensure that you have no extra risks of bone thinning
  • The Mirena coil can be used for contraception until the age of 55 if it is inserted over the age of 45. This is a popular, low-maintenance and reliable long-term contraception option with the added benefit of tending to make periods lighter  

Read Alice’s story about being fitted with a Mirena coil.

Choosing the right contraceptive during menopause can be quite complicated. Speak to your doctor for help on deciding the best option for you.

Do you really need to stop your combined pill at age 50?

Yes. While the combined pill is a convenient and reliable contraceptive for millions of women around the world, it does come with certain risks. These include blood clots (like DVT and PE), which have been found to be up to six times more likely in women taking the combined pill. There is also a small increased risk of breast cancer and potentially stroke and myocardial infarction (heart attack).

While these risks are extremely low in younger women, our background risk increases as we age. For this reason, current guidance suggests that doctors should only prescribe the combined pill ‘with caution’ from the age of 40, and should not prescribe it beyond 50.

Can I use the contraceptive pill as an alternative to HRT?

Yes. If you are aged under 50, the combined pill (containing both oestrogen and progesterone) can be used to help with menopause symptoms. It can also help to preserve your bone density. This is because it contains oestrogen, the hormone which helps to improve menopause symptoms.

However, while the combined pill can improve some menopause symptoms, HRT is generally thought to be more effective. 

It is also important to note that the combined pill is not suitable for everyone. Check in with your doctor to ensure it’s the right treatment for you. This particularly applies to those with a personal or family history of breast cancer, heart disease or blood clots (including DVT or PE).

Find out more about the risks and benefits of HRT.

Can I use the Mirena coil for HRT?

In part, yes.

If you still have your womb, you need to take two types of hormones for HRT:

  • Oestrogen, which helps to ease menopause symptoms
  • Progesterone, which protects the womb lining (endometrium) from the effects of oestrogen. These include abnormal thickening and even cancer of the endometrium, but are prevented by the use of progesterone

A Mirena coil can be used to provide the progesterone component of your HRT for up to five years (at which point a new Mirena would need to be fitted). This type of coil works by slowly releasing progesterone directly into the womb, therefore protecting the womb lining.

If you have a Mirena in place and want to use HRT, you simply need to add an oestrogen gel or patch to complete your treatment plan. Let your doctor know if you have a Mirena in place when discussing HRT and they will be able to advise.

Be aware that not all hormonal coils (IUS) are created equal! While the Mirena contains high enough levels of progesterone to protect your endometrium, there are other coils on the market which contain lower doses, or which have not been approved for use in HRT. Check with your doctor if you aren’t sure which you have.

Why do I need progesterone in my HRT if I am already on the mini pill?

If you are taking a mini pill (which contains progesterone), you may be surprised to hear that this cannot form part of your HRT treatment. 

This is because the mini pill, contraceptive injection and the implant have not yet been proven to protect the endometrium from the effects of the oestrogens found in HRT. They have therefore not been licensed for this use. 

If you are happy with the mini pill, you can continue taking it alongside combined HRT. That way, you have good contraceptive cover and appropriate HRT. The same goes for the implant and the injection.

Can you get sexually transmitted infections (STIs) after menopause?

Yes. Even if you can stop contraception after menopause, you still need to protect yourself from STIs, especially if you have a new partner or casual partners. 

The best way to prevent infection is to use condoms when you have sex, even if you don’t otherwise need contraception. If you are sensitive to latex, try latex-free condoms.

Schedule an STI check if you have a new partner or are in a non-monogamous relationship. This can be done by your doctor, at your local sexual health clinic or even by post.

Can you use vaginal moisturisers and lubricants with condoms?

Vaginal dryness is very common during menopause and can feel super uncomfortable. Vaginal moisturisers and lubricants can be very helpful but be aware that some of these products can damage condoms and make them ineffective. This is particularly true with oil-based products.

Always check the leaflet that comes with your moisturiser or lubricant for information on whether they can be used with condoms.

Will contraception affect your periods at menopause?

Some hormonal contraception can mask the signs and symptoms of menopause. 

It can also affect the pattern of your bleeding in the following ways:

  • The combined pill or patch tends to give people lighter and more regular periods. Monthly bleeds can continue even after menopause when you use this type of contraception, making it difficult to tell where you are in your menopause journey.
  • The progesterone-only pill (POP or mini pill) can cause irregular periods and spotting in some users, while others have no periods at all. This can also make it difficult to tell if you have reached menopause
  • The Depo injection and intrauterine systems (e.g. Mirena coil) are similar to the progesterone-only pill. They can cause periods to become lighter or more irregular, although some will have no periods while using these methods. 
  • The copper coil can cause heavier periods. If this is already a problem for you but you like the idea of a coil, it might be worth considering a Mirena (which tends to make periods lighter).

It is important to check in with your doctor if you have any heavy, irregular or unusual bleeding. The same goes for bleeding in between periods or after sex. Your doctor can check if these symptoms are due to your contraception, or if there is another underlying cause.

Will I need emergency contraception during menopause?

The rules for missed pills apply, whether you are menopausal or not. You should consider using emergency contraception if needed.

Final word

While menopause itself gives you plenty to think about, don’t let contraception slip your mind! You need an effective plan to prevent unwanted pregnancies and to protect yourself from STIs.

Speak to your doctor to find out the best options for you.

Read more about menopause on our blog or in our symptoms library.