Contraception and menopause
How long do I need to use contraception for?
Fertility declines naturally with age, and spontaneous pregnancy is very rare after age 50. However, women do still get pregnant spontaneously even into their 50s, so if you’re not planning a pregnancy, it’s important to continue to use contraception until you no longer need to.
If you’re under the age of 50, you’ll need to use contraception until two years after your last period, and if you’re over 50 until one year after your last period. After the age of 55, spontaneous pregnancies are very rare, so contraception isn’t needed after this time.
What contraception is best for older women?
This depends on your general health, your age, your preferences, and whether or not you’re taking hormone replacement therapy (HRT).
Combined hormonal methods
Combined hormonal contraceptives (available as pills, patches and vaginal rings) contain estrogen and progestogen (a synthetic form of progesterone) hormones, and can be used until the age of 50, as long as there are no health risks such as smoking, being overweight, a history of migraines, diabetes, cardiovascular disease or stroke.
Combined hormonal contraception can be used instead of HRT in some women but can’t be used with HRT.
The benefit of combined hormonal contraceptives in the period leading up to the menopause that they may be helpful in regulating periods, may relieve some troublesome menopausal symptoms, and help maintain bone mineral density, thereby helping to prevent the development of osteoporosis.
Progestogen-only methods
Progestogen-only contraceptives don’t contain estrogen and include the progestogen-only pill (or “mini pill”), the contraceptive implant and injection and intrauterine hormonal systems such as the Mirena IUS (also called the Mirena coil) – they can all be used alongside HRT and up to age 55 for most methods. The Mirena provides the double benefit of being a contraceptive as well as protecting the lining of the womb in women taking estrogen for HRT. It can therefore be used a part of your standard HRT regimen alongside estrogen. It is also helpful for irregular or heavy bleeding, as many women stop having periods on it.
Other contraceptive methods
These include the hormone-free copper intrauterine device (more commonly known as the copper coil), which is inserted into the uterus and can be left in place until after the menopause if inserted over the age of 40.
Barrier methods such as male and female condoms, caps and diaphragms, though less effective than hormonal methods in younger women, become more effective as you get older, and may be preferred by people who don’t want to, or can’t, take hormonal contraceptives. They also provide protection against sexually transmitted infections which hormonal methods don’t.
Finally, male (vasectomy) and female (tubal ligation [having your tubes tied or clipped]) sterilisation are permanent methods of contraception.
HRT and contraception
Hormone replacement therapy (HRT) doesn’t provide contraception as the hormone levels are very low so women who haven’t completed the menopause will need contraception if they aren’t planning a pregnancy.
All progestogen only methods of contraception can be used as contraception alongside HRT and most can be continued until the age of 55 (apart from the injection), when contraception is no longer needed.
The Mirena IUS can be used as part of standard HRT, providing both contraception and the progestogen component of HRT. When used a part of an HRT regimen it needs to be changed every 5 years.
Combined hormonal contraceptives such as the pill, patch and vaginal ring can be used instead of HRT up to age 50 in non-smoking women with no underlying health conditions.
