Before your periods stop altogether, it is likely that your periods will become irregular and unpredictable.
At what age will I stop being fertile?
The time of menopause varies tremendously between women. Before your periods stop altogether, it is likely that your periods will become irregular and unpredictable. Although you are less likely to produce an egg (ovulate) every month, your ovaries will still be producing some eggs and, for this reason, it is important that you consider using contraception. So, although there is a natural decline in your fertility after the age of about 37 years, effective contraception is still required to prevent an unplanned pregnancy. Most women will no longer be fertile by the age of 55 years. However, a few women will still be having periods at this age and may need contraception. The average age at which women get to their menopause in the UK is 51 years.
When can contraception be safely stopped?
If you are using contraception that does not contain hormones, you will be able to stop using contraception one year after your periods stop if you are aged over 50 years. If you are aged under 50 years, you should use contraception until two years after your periods stop.
However, if you are using hormone-based contraception then your periods (withdrawal bleeds) are not a reliable way of knowing if you are fertile or not. Some women who take hormone-based contraceptives will have irregular or no periods but they will still be fertile if they stop using their contraceptive. The ages for stopping the different hormone-based contraceptives are detailed below.
Clinical Editor's comments (September 2017)
Dr Hayley Willacy recommends the Faculty of Sexual and Reproductive Health's latest guidelines on Contraception for women aged over 40 years - see 'Further Reading and References', below. The guideline updates information relating to when women no longer require contraception. Progestogen-only pills, progestogen-only implants, levonorgestrel intrauterine systems and copper intrauterine devices can safely be used until the age of 55 and may confer non-contraceptive benefits such as reduced menstrual pain and bleeding and endometrial protection. During perimenopause, isolated serum estradiol, FSH and luteinising hormone levels can be misleading and should not be used as the basis for advice about stopping contraception; ovulation may still occur with a risk of pregnancy.
What are the different methods of contraception available?
Your choice of contraception when you are over the age of 40 years may be influenced by:
- How effective it is.
- Possible risks and side-effects.
- Your natural decline in fertility.
- Personal preference.
- If you have a medical condition that needs to be considered.
Many women over the age of 40 will have just the same options available to them as younger women, but may have different priorities. Read the overview of all options in contraception methods. The following information lists the options, linking to individual leaflets, and commenting on any aspects specific to women between the age of 40 and the menopause.
Hormones, pills, patches and rings
The combined oral contraceptive (COC) pill is often just called "the pill".
There are some specific advantages to the COC pill for more mature women. Taking the COC pill may improve period problems such as heavier or irregular periods which may occur as you approach your menopause. They may also help with any menopausal symptoms that you may have. There is also some evidence that taking the COC pill when you are aged over 40 years may increase the density of your bones. This means your bones are stronger and may be less likely to fracture when you have gone through the menopause. The COC pill can safely be taken by women over the age of 40 years with no other medical problems.
However, for some women, the COC pill may have more risks as they get older. You should not take it if you are aged over 35 years and a smoker. You should not take it if you are aged over 35 years and have migraine. You also should not take it if you have a history of stroke or heart disease, or if you are very overweight. Women who have complications from diabetes (including problems with eyes, blood vessels or kidneys) should not take the COC pill. These are just a few of the conditions which make it unsafe to take the COC pill. Your doctor or healthcare professional will go through your medical history with you to decide if it is safe for you personally. If you have no medical problems or risk factors for medical problems, the COC pill can be taken until the age of 50 years.
You should stop taking the COC pill and use another form of contraception when you reach the age of 50 years.
The progestogen-only pill (POP) is sometimes called "the mini-pill". It is commonly taken if the COC pill is not suitable - for example, breastfeeding women, smokers over the age of 35 years and some women with migraine.
The POP is safe if you have previously had a stroke or a heart attack, or if you have developed a clot in the past. There is no increased risk of developing breast cancer if you take the POP. However, women who have had breast cancer cannot usually take a POP.
The POP can be continued until you reach the age of 55 years, after which time you will probably no longer need to use contraception. Blood tests can be done if you are not sure if you have gone through your menopause.
The contraceptive patch (Evra®) can safely be used by women over the age of 40 years with no other medical problems. However, you should not use it if you are aged over 35 years and a smoker, or are aged over 40 years and have cardiovascular disease, or a history of a stroke or migraine. You should stop using the patch and use another form of contraception when you reach the age of 50 years.
Contraceptive vaginal ring
The contraceptive vaginal ring has similar risks to the patch and COC pill. As with the patch and COC pill, you should not use it if you are aged over 35 years and a smoker, or are aged over 40 years and have cardiovascular disease, or a history of a stroke or migraine. You should stop using the contraceptive ring and use another form of contraception when you reach the age of 50.
These include male condoms, the female condom, and diaphragms and caps. These are all suitable and safe for women between the age of 40 and menopause. However, they are less effective than other methods of contraception, so if it would be a disaster to become pregnant, you may wish to consider alternative choices. If you do use these methods, make sure you use them correctly. If you forget, or if you use a condom and it splits, for example, then consider emergency contraception.
Natural methods of contraception involve being able to predict your fertile time - effective if done correctly. It requires commitment and regular checking of fertility indicators such as body temperature and cervical secretions. This is less likely to be an effective method around the time of menopause if your periods have become irregular and unpredictable.
Long-acting reversible contraceptives
Long-term use of the progestogen-only injection can be associated with a reduction in the strength (density) of your bones. However, this returns to normal after stopping using the injection. Bones become thinner after the menopause, so this may be a factor for you and your healthcare professional to consider when choosing your contraception.
The contraceptive injection is usually stopped when you reach the age of 50 years and another method of contraception should then be used.
The contraceptive implant (Nexplanon®) can be continued until you reach the age of 55 years, after which time you will no longer need to use contraception. If you think you have had your menopause before this, some blood tests may help to confirm this. If you have become menopausal then the implant can be removed one year after if you are over 50 years, and two years after if not.
The implant has not been shown to increase your chances of having a blood clot (thrombosis) or to cause bone thinning. It may be a good option for women who might avoid other forms of contraception which do have these risks.
Intrauterine contraceptive device
The intrauterine contraceptive device (IUCD) lasts for up to ten years, so may be a good option when you have completed your family. If you have an IUCD inserted when you are aged 40 years or over, this can remain in place until you have gone through the menopause and no longer require contraception. That is, for one year after your periods stop if you are aged over 50 years, or two years after your periods stop if you are aged under 50 years. So in some cases when it is fitted after the age of 40, it can last for more than ten years.
The hormone-releasing intrauterine device called an intrauterine system (IUS) can be continued until you reach the age of 55 years, after which time you will probably no longer need to use contraception. If you have an IUS put in at the age of 45 years or older, you may be able to keep it longer than the usual five years before removing it.
The IUS can also be used as a part of hormone replacement therapy (HRT) in some women. This may be particularly useful around the start of the menopause.
Sterilisation - a permanent method of contraception
You and your partner may have decided that you would like a more permanent method of contraception. Sterilisation involves an operation. It is more than 99% effective; however, even sterilisation can fail. Options include:
Can I still use emergency contraception?
Emergency contraception can be used at any time if you had sex without using contraception. Also, it can be used if you had sex but there was a mistake with contraception. For example, a split condom or if you missed taking your usual contraceptive pills. Options include pills or an IUCD and are suitable for most women between the age of 40 and the menopause.
Can hormone replacement therapy be used for contraception?
As hormone replacement therapy (HRT) contains very low levels of hormones, it does not work as a contraceptive. Unless you went through the menopause (had no period for one year if aged over 50 years or for two years if aged under 50 years) before you started HRT, you should use contraception until you are aged 55 years.
If you are taking HRT but still need contraception then you can take the POP or have an IUCD or IUS inserted. Alternatively, many women choose to use barrier methods of contraception. As above, the IUS can be used as part of your HRT (you still need the oestrogen, but the IUS provides the progestogen part) so is a good option if you need contraception and HRT.
Further reading and references
; Faculty of Sexual and Reproductive Healthcare (2010)
; Faculty of Sexual and Reproductive Healthcare (2011 updated August 2012)
; Contraceptive failure in the United States, Contraception, 2011
; NICE Clinical Guideline (September 2014)
; Faculty of Sexual and Reproductive Healthcare (March 2015 - updated January 2016)
; Faculty of Sexual and Reproductive Healthcare (December 2014)
; Faculty of Sexual and Reproductive Healthcare (Feb 2014)
; Faculty of Sexual and Reproductive Healthcare Clinical Effectiveness Unit (2015)
; Faculty of Sexual and Reproductive Healthcare, 2016
; Faculty of Sexual and Reproductive Healthcare (September 2014)
; Faculty of Sexual and Reproductive Healthcare (June 2015 - updated November 2015)
; Faculty of Sexual and Reproductive Healthcare (March 2017 - updated May 2017)
; Faculty of Sexual and Reproductive Healthcare (January 2017)
; Faculty of Sexual and Reproductive Healthcare (August 2017)
; NICE CKS, August 2016 (UK access only)
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