Sex & relationships

Why you still need contraception during perimenopause

by Dr Sonia Dua

Contraception in perimenopause is often overlooked but you can still get pregnant. You need to continue to use contraception to avoid unplanned pregnancy if you are under 55 years of age or are not postmenopausal (when a woman with ovaries hasn’t had a period for a year and isn’t using hormonal contraception). You also need to use contraception to prevent sexually transmitted infections (STIs) if you have new partners.

Women in their 30s are frequently reminded that their biological clock is ticking and fertility is rapidly declining. It’s no wonder women approaching menopause have a false sense of security, assuming it is virtually impossible to get pregnant. While it may not be quite as easy to get pregnant as you get older, it is still entirely possible.

I will never forget the horrified look of a woman approaching her 50s and a grandmother of three when I told her that her periods had stopped because she was pregnant and not due to menopause. She genuinely believed she did not need contraception at her age.

If the thought of nappy changes, breastfeeding and sleepless nights are not in your plans for midlife, you might also want to know that pregnancy in older women is associated with higher risks to both mother and baby.

Why do menopausal women need contraception?

Pregnancy is rare in women over 50, but effective contraception is still necessary to prevent unplanned pregnancy.

The average age of menopause is 51 and is usually diagnosed when a woman experiences the physical symptoms of hot flushes, night sweats and her periods have ceased for at least a year without hormonal contraception. Some hormonal contraception can cause periods to stop as a side effect of the medication, rather than it being the indicator for menopause.

This means it can all be rather confusing and that’s why it’s so important for menopausal women to carry on with contraception. Read more about the stages of menopause

What are the best contraception methods for menopausal women?

In theory, women over 40 may be considered for all forms of contraception. Individual risk factors and personal preference may help decide which contraception is most suitable for you.

Non-hormonal options

These include condoms and the intrauterine device, such as the copper coil. Barrier methods, such as condoms, protect against STIs but they are the least reliable contraception in terms of failure rate. The copper coil can be a good long-term option for menopausal women and if inserted over the age of 40 years old, it can remain in place until menopause.

Hormonal options

These can be divided into progesterone only or combined hormonal contraception containing oestrogen and progesterone. It is possible to have the combined hormone contraceptive pill, patch, or vaginal ring, these tend to be less favourable with increasing age due to the increasing risks of blood clots, cardiovascular disease and breast cancer. Combined hormonal options are not a common choice during perimenopause, especially as it must be switched for all women by the age of 50.  

Progesterone only contraceptive options tend to be much safer than those containing oestrogen, especially for women with certain risk factors. Progesterone only options include the progesterone only pill (referred to as the mini pill or POP), Depo-Provera injections, the Mirena intrauterine system and implants:

  • The Depo injection can affect bone health and tends to be worse in women over 50, so it is rarely offered around menopause
  • The Mirena coil can be used for contraception until the age of 55 if it is inserted over the age of 45. This tends to be quite a popular and reliable long term contraception option. Read Alice’s story about being fitted with a Mirena Coil
  • The progestogen-only implant tends to be a safe option too that can be used until menopause, but needs changing every three years

Overall, the intrauterine device (copper coil) or intrauterine systems (eg Mirena coil) or the implant are probably the best long-term contraception solution during menopause.

The use of condoms in conjunction with one of the long-term contraceptives is good practice to reduce the risk of sexually transmitted infection. Every woman is different and it’s important to discuss the suitability of contraception with your own doctor”

When can you stop contraception?

In terms of preventing pregnancy, you can completely stop contraception once you hit age 55, according to the Faculty of Sexual Health and Reproduction (FSRH). Spontaneous conception after this age is rare, even in women still experiencing periods. If you are using non-hormonal contraception and you are absolutely certain you have reached menopause (that is no periods for a year and not on hormonal contraception), you can stop contraception at this point.

STIs, menopause and risk

You may be able to stop contraception after menopause, but it is still recommended to reduce STIs, especially if you have a new partner or casual partners. Chlamydia, gonorrhoea, herpes, genital warts and even HIV do not discriminate by age or menstrual status.

Condoms can be used in conjunction with other contraceptives during perimenopause and continued even when contraception is no longer required.

If you are embarking on a new relationship, pop along to a sexual health clinic with your partner for some swabs, ideally, before becoming intimate, or order a home testing kit from the NHS. This may not sound very romantic, but it’s the responsible thing to do to keep yourself safe!

What if you are sensitive to latex?

Men and women sometimes report irritation from using condoms and a true latex allergy can cause rashes on contact with the latex. Fortunately, latex-free condoms are readily available to help you have safe sex.

Effect of using vaginal moisturisers and lubricants on barrier methods of contraception?

During menopause, women may experience vaginal dryness and the use of vaginal moisturisers and lubricants can really help. These can be water or oil-based. Avoid oil-based products if you are using latex condoms as they can damage them. Always double-check the lubricant’s information leaflet.

Bleeding and different methods of contraception

Contraception does not affect the onset or duration of menopausal symptoms, however, some hormonal contraception can mask some of the signs and symptoms. 

Bleeding patterns can vary considerably depending on the type of contraception used:

  • The combined pill or patch tends to give people lighter and regular periods. Periods can continue even postmenopause, so it can be a little confusing
  • The progesterone-only (POP or mini pill) can result in some women experiencing irregular periods and spotting, while some get no periods at all. It can be tricky to know when you reach the menopause
  • The Depo injection and intrauterine systems (eg Mirena coil) tend to be quite similar to the mini pill, as they have a similar hormone profile
  • The copper coil tends to give people slightly heavier periods and, sometimes, more painful periods. The periods tend to be as regular as your usual cycle, as it’s non-hormonal contraception. Women prone to heavy periods tend to stay away from the copper coil, whereas the Mirena coil may be more favourable

As some contraceptive methods stop periods, it can be tricky to know when you have had your last period. This is why age 55 tends to be the advised cut-off when contraception can be stopped.

Do the same rules apply if you miss a pill even though you are perimenopausal?

The rules still apply for missed pills even if you are menopausal and emergency contraception should be used where required. Ultimately, for as long as you don’t want to get pregnant, it’s important to remember your contraception.

Find out more about the stages of menopause, and more on our blog.