Do you still need contraception? Which contraception is right for you? Here’s how to find the option that best suits you
• Usually, women can stop using contraception aged 55 but the age you are menopausal has an influence
• There are lots of contraception methods, but each one has its pros and cons
• Hormone treatments (HRT) contain very low levels of hormones so do not usually work as a contraceptive
Although pregnancy is less likely during perimenopause and menopause, it’s still important to use contraception to prevent an unplanned pregnancy. This is because it is possible to ovulate (produce an egg) when you are having periods, even if they are irregular.
The rate of women getting pregnant in their 40s is increasing. While most women in their 40s will have healthy pregnancies and babies, statistically there is an increase in complications. Contraception is especially important in this age group to prevent an unplanned pregnancy.
RELATED: Can I still get pregnant during perimenopause?
What is the best type of contraception?
There are various types of contraception available:
Barrier methods include male condoms, female condoms, diaphragms and cervical caps, all of which can be used at any age. Male and female condoms are crucial for women in newer relationships and/or where there is any risk of a sexually transmitted infection.
The combined oral contraceptive pill (COCP) usually needs careful consideration in women over the age of 40. It should be avoided over the age of 35 if you smoke or are overweight.
Although some clinicians prescribe the combined oral contraceptive pill as an alternative to hormone treatments (HRT) for perimenopausal women, there are more risks associated with it than natural bioidentical hormones. This is because they all contain synthetic hormones, which work differently in the body than your own hormones or to bioidentical hormone treatments. All synthetic contraceptives are associated with a small risk of heart attacks, clot, stroke and cancer.
Zoely is a combined oral contraceptive that contains bioidentical estradiol (estrogen) and a newer type of progestogen, nomegestrol acetate (NOMAC). Estradiol is not associated with these risks. A review of five studies involving more than 560,000 women found a significant 33% reduction in venous thromboembolism (clot) risk among users of natural estradiol-based COCPs compared to synthetic estrogen-based COCPs that contain ethinylestradiol [1].
RELATED: Non-hormonal contraception: what’s right for you?
The progestogen-only pill (POP, also known as the ‘mini-pill’) contains progestogen, a synthetic type of progesterone that is associated with more side effects and risks than natural bioidentical progesterone. Although the POP can help with heavy, painful periods, natural bioidentical progesterone is often preferable.
The contraceptive injection (Depo Provera and Sayana Press) is a three-monthly injection. However, it contains the synthetic progestogen medroxyprogesterone acetate and is associated with more risks and side effects compared to natural bioidentical progesterone. It has been known for many years to be associated with an increased risk of developing cancer and osteoporosis. It blocks the production of estradiol in the body.
The contraceptive implant is a small plastic rod that is inserted under the skin of your upper arm and lasts for three years. Bleeding with this can be very variable – periods may become irregular, stop altogether or last for longer. The implant may help with heavy, painful periods. However, it contains synthetic progestogen and is associated with more risks and side effects compared to natural bioidentical progesterone.
The progestogen-onIy pill, contraceptive injection and contraceptive implant can all be used alongside hormone treatments (HRT), if needed.
RELATED: How do perimenopause and menopause affect my sex drive?
Coils
There are several types of coil:
The copper coil is hormone free. If it is inserted after the age of 40, it can usually be left in place until after menopause.
The Mirena coil contains a small amount of a progestogen, which is released gradually. During perimenopause, the Mirena coil has three potential uses: as a contraceptive; a treatment for heavy periods (it can reduce blood loss by more than 90% over six months for most women with heavy menstrual bleeding periods [2]); and it can be used with estrogen as part of hormone treatment (HRT) to protect the lining of your womb, although it does not work the same as progesterone so increasingly women are being prescribed progesterone as well as having a Mirena coil. If being used as part of HRT, the Mirena coil needs changing after five years. If being used solely for contraception, then it can be used for eight years. If solely for heavy periods, then the Mirena lasts for five years.
RELATED: The Mirena coil: everything you need to know
Levosert and Benilexa are “hormonal” coils that also contain progestogen at the same dose as the Mirena coil, 52 mg of Levonorgestrel. Like the Mirena, they can be used as contraception, as a part of hormone treatment (HRT) or for heavy periods, the only difference being that if used for heavy periods then they have only been shown to be effective for up to three years rather than the five years seen with the Mirena.
The Kyleena coil contains progestogen and is used for contraception alone. It is slightly smaller than the Mirena and needs changing every five years.
The Jaydess coil also contains progestogen, is available for contraception and needs changing every three years.
RELATED: Coils for contraception what you need to know
Other options
Sterilisation can be undertaken for men and women. For men, it is safe and usually quick and easy to perform. In comparison, female sterilisation is associated with more risks. Female sterilisation does not usually alter or eliminate periods.
When can contraception be safely stopped?
The current guidelines are that if you are under 50 years old, then you should use contraception for at least two years, following your last menstrual period. If you are over 50, then you should use contraception for at least one year following your last menstrual period [3].
However, if you are taking the combined contraceptive pill, your periods are happening because of the withdrawal bleeds from the Pill, rather than due to your own menstrual cycle. If you’re using a progestogen-only contraception such as the POP, implant, injection or hormone-containing coil, you might not have any periods, which can make it difficult to know when your menopause occurs.
If you are uncertain when your last period was, you can have a blood test to check your follicle stimulating hormone (FSH) level. If this hormone is elevated, you will need to continue using contraception for two years if you are under 50 years old, or one year if you are over 50 years old. This test is a guide rather than being totally accurate.
You will need to stop taking the combined contraceptive pill at least six weeks before this blood test is taken to get an accurate result, so use adequate protection in the meantime. However, if you are using the Mirena coil or POP, there is no need to remove/stop these. High doses of progestogens, such as those seen in the contraceptive injection, may affect the FSH result.
In general, all women can stop contraception when they are 55 as natural conception after this age is exceptionally rare, even in women still having some periods.
RELATED: Sex and the menopause: Samantha Evans and Dr Louise Newson
Can HRT be used for contraception?
As hormone treatment (HRT) contains very low levels of hormones, it does not usually work as a contraceptive. If you are taking HRT, you should consider other methods of contraception, if you require contraception. However, if you are taking a type of hormone treatment that does not lead to periods then contraception is usually not necessary but you should discuss this with your healthcare professional.
RELATED: Which contraception is right for you?
