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Birth Control in Perimenopause

Updated: Dec 11, 2020

Did you know that 77% of pregnancies for women over 40 are unintended? This is only slightly lower than the 82% unintended pregnancy rate for 15-19 year olds. What is going on for women as we enter our 40s?

For many women with unintended later pregnancies, they didn't think they could become pregnant. Perhaps knowing friends who couldn't conceive over 40, or noticing their own perimenopausal cycle changes made them underestimate their risk. Once they became pregnant they were faced with a new reality: a pregnancy that affects their life plans and carries increased risks to mom and baby (compared to pregnancy in the 20s or 30s), or ending the pregnancy. Either way, a reality most of these women weren't planning on.

So, for those with a fertile male partner who don't want to become pregnant, how do you know when it's safe to stop contraception? We can safely say that you won't become pregnant when we know you are in menopause. For women who get periods, this means after 12 months with no periods. This might seem like a long time to wait, but pregnancies over even age 50 are regularly seen. It's difficult to predict who might beat the infertility odds and become pregnant at this age, but anyone still having cycles is a candidate. If an unplanned pregnancy would be a big deal in your life, keep using birth control until you know you're in menopause.

But sometimes, the contraception you are using might make it hard to know when you are in menopause. For instance, taking birth control pills with scheduled periods causes monthly bleeding, so you wouldn't know if your periods would have stopped on their own. At the same time, continuous birth control, depo and hormonal IUDs might stop monthly bleeding altogether, erasing any clues you might have about the timing of menopause.

In these cases, providers and patients work together to make a plan. It may involve temporarily stopping a method, using blood tests, or both. Or, rather than worrying about timing and blood tests, many providers will advise women to use contraception through age 55. This overshoots the average age of menopause (51.5) by several years. When contraception is stopped at age 55 the chances of accidental pregnancy are very low. If a woman notices menstrual cycles after stopping the contraception, the same method or a new method could be restarted, and a new plan made for when to stop.

The contraception you choose as you approach menopause may not be the same one that worked for you in the 20s or 30s. The way your own body experiences perimenopause may lead you to explore changing methods. If irregular cycles are disruptive, a method with a planned cycle such as pills, rings or patches might be helpful. Or, consider skipping periods altogether. If heavy bleeding has appeared, you may consider switching to a low-hormone IUD. Lasting 5 years or longer, this estrogen-free method reduces heavy menstrual bleeding, without increasing risks for blood clots or stroke like other methods that control bleeding. Another bonus of an IUD: for those who end up using estrogen therapy to control menopausal symptoms, the IUD can also provide protection for the uterus from unwanted effects of estrogen.

Sometimes other changes of midlife require a contraception change as well. Perimenopausal cycle irregularity may make fertility awareness methods impractical. Perhaps condoms become difficult to use with a male partner who develops erection problems. Or maybe a woman has developed new health risks that require a change to an estrogen-free method. In these situations, your provider can help you find a safe, acceptable method to see you through the end of the reproductive years. Sterilization (permanent birth control) is also an option that women find convenient and final.

It can be frustrating to be dealing with contraceptive changes and body changes in the late reproductive years. Let your provider know what you would like in a contraceptive method and ask them to make a plan with you about when you will stop it.


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