Do You Need Birth Control in Your 40s and 50s?

If you are in your 40s or early 50s and approaching menopause, you might wonder if you can stop using birth control. Before doing anything, talk to your doctor because pregnancy is still possible. And you may need some method of birth control longer than you think.

Here’s what you should know about birth control in your 40s and 50s and the best contraceptive for perimenopause.

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Perimenopause vs. Menopause

Menopause marks your last period. It’s the end of ovulation when you can no longer get pregnant, so you can safely stop birth control. The average age of menopause is 52, but it can happen earlier or later.

Unfortunately, there is no test to tell if you’ve gone through menopause. Doctors usually diagnose it if you’re in your 50s and haven’t had a period for at least 12 consecutive months.

Perimenopause is the time leading up to menopause. It usually starts in your 40s, and it often lasts years. During perimenopause, your hormone levels change as your body produces less estrogen, causing:

  • Hot flashes and night sweats.
  • Irritability or mood swings.
  • Missed periods or bleeding that is longer, shorter, lighter, or heavier than usual.
  • Trouble falling asleep or staying asleep.
  • Vaginal dryness and pain with sex.

These symptoms start during perimenopause but often continue into the first few years after menopause. That’s why it’s hard to tell exactly if and when you’ve gone through menopause.

And although you can’t get pregnant after menopause, you can during perimenopause. That’s true even if you haven’t had a period in several months.

Birth Control and Perimenopause

Your fertility decreases as you approach menopause. Fluctuating hormone levels cause ovulation (when you release an egg) to slow down. You might only release an egg every few months, and egg quality decreases, making you less likely to conceive.

Still, you may occasionally ovulate, which means if you’re sexually active, there is a chance you can get pregnant during perimenopause. Talk to your doctor if you’re trying for a baby after 40. Pregnancy after 40 has significantly higher risks for you and your baby, so good medical care is essential.

But if you’re worried about pregnancy and don’t want a baby, you’ll probably need birth control in your 40s and 50. Most doctors recommend birth control for one full year after your last period.

Best Contraceptive for Perimenopause

Various forms of hormonal and nonhormonal birth control are effective for perimenopausal women. The best choice depends on your age, health risks, and preference.

Hormonal contraception uses hormones to stop ovulation and sometimes thicken cervical mucous, making it unfriendly to sperm. Hormonal birth control is highly effective at preventing pregnancy. It includes:

  • A birth control ring you insert in your vagina every month.
  • A birth control patch you apply to your skin each week.
  • A hormonal IUD a doctor inserts in your uterus. It lasts for several years or until removed.
  • An implant a doctor places under the skin of your arm. It lasts for three years or until removed.
  • Birth control pills you take every day.
  • Shots you receive every three months.

Nonhormonal birth control is another option. It doesn’t affect your hormones. Instead, it prevents pregnancy by acting as a barrier, blocking sperm from your uterus or killing sperm before it fertilizes an egg.

These are all forms of nonhormonal birth control:

  • A copper IUD. A doctor places this T-shaped device in your uterus. The copper coating is toxic to sperm.
  • A diaphragm or cervical cap. These fit over your cervix, blocking sperm from entering your uterus. You must insert it before having sex.
  • Condoms. These are available for men or women and block sperm from entering your uterus. You must wear it every time you have sex.
  • The sponge. This works like a diaphragm and helps block sperm, but it also has a spermicide that is toxic to sperm.
  • Vaginal gels or spermicides. These are chemicals you put in your vagina to inactivate sperm.

The copper IUD is very effective at preventing pregnancy. But the other forms of nonhormonal birth control are less effective. To increase effectiveness, you can use two forms, like a condom plus spermicide or a diaphragm plus a male condom.

You should also know some barrier birth control methods might have side effects. These include vaginal irritation or increased risk of urinary tract infections.

Pros and Cons of Hormonal Contraception

Hormonal contraception is effective and convenient, but it has pros and cons for women after the age of 35. Discussing it with your doctor is essential because no single solution suits everyone.

Using hormonal birth control during perimenopause has these benefits:

  • It can reduce bone loss, which starts to accelerate before menopause.
  • It can reduce hot flashes and other perimenopause symptoms.
  • It decreases your risk of uterine and ovarian cancer.
  • It makes your periods regular and often lighter.
  • When used correctly, most forms are 99% effective at preventing pregnancy.

But using hormonal birth control in midlife also comes with these risks:

  • It might increase your risk of blood clots, breast cancer, a stroke, or a heart attack. The risk is highest if you use birth control with estrogen and you smoke.
  • Birth control with estrogen and progestin will cause menstrual-like bleeding when you stop it, even after menopause.
  • Hormonal birth control can mask the symptoms of perimenopause, making it hard to know when it’s happening.

Depending on your age, health, and risk factors, your doctor might recommend using a lower dose of hormonal birth control. Or they might recommend using a nonhormonal method.

What’s Not Recommended for Contraception

Because your hormones fluctuate during perimenopause, you can’t rely on natural family planning, also called the calendar or rhythm method. It requires tracking your monthly cycle and pinpointing when you ovulate to avoid sex around ovulation time. But when your periods become irregular, predicting when you ovulate is nearly impossible.

You also shouldn’t rely on changes in the consistency of your cervical mucus. This method is also unreliable because as your hormones change, your cervical mucus can change too.

Therefore, doctors don’t recommend using natural family planning methods to prevent pregnancy during perimenopause.

The years leading up to menopause are full of changes and questions, including which birth control is best for you. No one-size-fits-all solution exists, so talk to your doctor about your options. They can help you choose the best method and tell you when it’s safe to stop using birth control.

US Department of Health and Human Services Office on Women's Health. Menopause Basics. LINK

North American Menopause Society. Contraception: You Need It Longer Than You May Think. LINK

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Our Magee-Womens network – from women’s imaging centers and specialty care to outpatient and hospital-based services – provides care throughout Pennsylvania, so the help you need is always close to home. More than 25,000 babies are born at our network hospitals each year, with 10,000 of those babies born at UPMC Magee in Pittsburgh, home to one of the largest NICUs in the country. The Department of Health and Human Services recognizes Magee in Pittsburgh as a National Center of Excellence in Women’s Health; U.S. News & World Report ranks Magee nationally in gynecology. The Magee-Womens Research Institute was the first and is the largest research institute in the U.S. devoted exclusively to women’s health and reproductive biology, with locations in Pittsburgh and Erie.