Contraception and the menopause, what you need to know
Contraception and the Menopause: What You Need to Know
There is a common myth that pregnancy is no longer possible during the perimenopause. In reality, this is not the case. Ovulation can still occur during the perimenopausal years—and occasionally even after menopause (defined as 12 months after your last period). While fertility naturally declines with age and pregnancy over 50 is uncommon, it is not impossible. It’s also important to recognise that pregnancy after 40 carries increased health risks for both mother and baby.
Do You Still Need Contraception?
Yes—contraception remains necessary until menopause is confirmed.
If your periods stop before age 50: continue contraception for 2 years
If your periods stop after age 50: continue contraception for 1 year
Over age 55: contraception is usually no longer required, even if occasional bleeding occurs
Although contraception does not influence when menopause begins, hormonal methods can mask symptoms, making it harder to recognise when menopause has occurred.
Choosing the Right Contraception
Your choice of contraception should be tailored to your health, lifestyle, and preferences. Women over 40 may have additional considerations, including:
Increased risk of cardiovascular disease
Bone density changes (osteoporosis)
Higher risk of certain cancers (breast, ovarian, endometrial)
Reduced risk of cervical cancer
During perimenopause, fluctuating and declining oestrogen levels can cause symptoms such as hot flushes, irregular periods, and mood changes. Some contraceptive methods can help manage these symptoms alongside preventing pregnancy.
Non-Hormonal Contraceptive Options
Condoms
Provide protection against sexually transmitted infections (STIs)
Recommended to protect again infection even when contraception is no longer required for pregnancy prevention
Diaphragm
A barrier method used with spermicide
Hormone-free option
Copper Coil (IUD)
Long-acting, hormone-free method lasting up to 10 years
If fitted after age 40, it can remain in place:
Until 2 years after your last period (if under 50)
Until 1 year after your last period (if over 50)
Hormonal Contraceptive Options
Combined Oral Contraceptive Pill
Contains both oestrogen and progesterone.
Benefits:
Regulates periods
Reduces heavy bleeding and menstrual pain
Can improve menopausal symptoms
Considerations:
Typically used until age 50
Lower-dose oestrogen pills are preferred in women over 40
Not suitable if you:
Smoke and are over 35
Have a history of blood clots
Have clotting disorders
Have a BMI over 35
A personalised discussion with your doctor is essential.
Progesterone-Only Methods
Progesterone-Only Pill (POP)
Taken daily without a break (apart from Slynd which has a 4 day break)
Suitable for many women who cannot take oestrogen
Injectable Contraception
Given every 3 months (including self-injection options)
Can be used until age 50
Important:
May reduce bone density—ensure adequate calcium, vitamin D, and regular weight-bearing exercise.
Implant (e.g. Nexplanon)
A small rod placed under the skin
Lasts for 3 years
Hormonal Coil (IUD)
Available in several types lasting 3–8 years.
Benefits:
Highly effective contraception
Reduces heavy periods
Many women experience lighter or no bleeding over time
If inserted at age 45 or older, it can often be used for contraception for up to 10 years.
Certain hormonal IUDs (mirena, benilexa, levosert) can also serve as the progesterone component of hormone replacement therapy (HRT) for up to 5 years.
Bleeding Patterns on progesterone only methods
With progesterone-only methods, bleeding patterns can vary:
Regular bleeding
Irregular spotting
No bleeding at all
All of these patterns can be normal, but any unexpected or concerning bleeding should be reviewed by a healthcare professional.
Risks of Hormonal Contraception
There is a very small increased risk of breast cancer associated with all hormonal contraceptive methods. However, this risk must be weighed against the benefits and your individual health profile.
Key Takeaways
Pregnancy is still possible during perimenopause
Contraception should continue until menopause is confirmed
Many contraceptive options can also help manage menopausal symptoms
The safest and most effective choice depends on your individual health and preferences
Need Personalised Advice?
Choosing the right contraception during perimenopause can feel complex—but it doesn’t have to be. If you’d like tailored guidance based on your health, lifestyle, and symptoms, book a consultation today.
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