“I’m 49 and haven’t had a period in six months. Can I quit taking the Pill?”

Sure! If you use condoms.

Women in perimenopause have the second highest rate of unintended pregnancies in the US – right after teenagers. And while the rates of teen pregnancies have been dropping, peri-pregnancies are on the rise. (STDs in over-40s are also rising, so about those condoms…)

Some of this increase is intentional, as fertility medicine makes it possible for women to push childbearing back and concentrate on their careers. However, women pre-menopause can still have as high as a 5 – 10 percent chance each month of finding themselves on “the plus side of the pee stick,” as one older mom described it.

The prevailing wisdom is: until you’ve gone 12 full months without a period, you should use some sort of birth control if you don’t want to get pregnant.

So what are your perimenopause birth control options?*

Depending on your health and history, you have a pretty wide range of choices:

  1. Oral Contraceptives (the Pill). There are progestin-only and estrogen-progestin options and a range of dosages.
  2. Hormonal contraceptives delivered in other ways such as injection, patch, or vaginal ring.
  3. IUD (intrauterine device) – with or without hormones.
  4. Sterilization (you and/or your partner)
  5. Barrier methods (male and female condoms, sponge, diaphragm, spermicide)
  6. Rhythm method (tracking your cycles and abstaining during fertile times)

Considerations with perimenopause birth control

There are a few things to consider when choosing your birth control:

Oral, hormonal birth control (like the Pill) that contain a combination of estrogen and progestin can help a woman manage many perimenopausal symptoms like irregular periods, hot flashes, acne, and bone loss. They may also help prevent uterine and ovarian cancer.

However: because combination oral contraceptives do help manage perimenopause symptoms, it can be hard to tell where you are in the transition. When you stop taking the Pill, you’ll have withdrawal bleeding, which mimics a period – even after menopause. You may need to stop for some time and then have FSH levels tested, but obviously use another method during that pause.

Additionally: estrogen-containing contraceptives are not appropriate for women who have a history (personal or family) of estrogen-dependent cancer, high blood pressure, diabetes, blood clots, or heart disease.

Finally: women who are over 35 and smoke shouldn’t. And they shouldn’t take hormonal contraceptives, either.

Contraceptive injection may increase the risk of osteoporosis. Women who are at high risk or who smoke should probably find another option.

Sterilization and/or long-term contraception such as implants may not be the best options as they are rather invasive for a woman at a low risk of unintended pregnancy.

Female condoms can be awkward to use for the inexperienced, but they are well lubricated and may reduce or eliminate the pain of intercourse for a woman with vaginal dryness. Male condoms have to be used consistently and according to instructions to be effective, and breaks do happen. If you’re using a lubricant, be sure your condoms and your lubricant are compatible.

(Read: How to choose your lube!)

The rhythm method (also “natural family planning”) may not be appropriate for a woman in perimenopause as irregular periods can make it hard to track her cycle and establish when she’s fertile or not.

One procedure we are asked about in regards to birth control is endometrial ablation. This procedure destroys a thin layer of the uterine lining, lightening or sometimes stopping bleeding during menstruation. In fact, it’s usually done to manage heavy bleeding, when medications don’t solve the problem. Because it is possible (though not recommended) to get pregnant after an ablation, this should NOT be considered a method of birth control.

The good news is, you have options. But you do need to do some research here, determine your goals and comfort level, and consult with a doc about risks and benefits. One great benefit of menopause is freedom from fear of unwanted pregnancy, so celebrate! Just not too soon. 

*As always, this blog is for informational purposes only and should never be considered a replacement for expert advice from a health care professional. If you’re looking for a birth control method, talk with your doc about your history, lifestyle, and choices.

What’s your birth control story? We’d love for you to share with us, so shoot us an email at info@genneve.com, share with us in the comments section below, or join us on our Facebook page or closed Facebook group, Midlife & Menopause Solutions.

Consulted sources: NAMS, Women’s Health Concern, ACOG

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Shannon Perry

Shannon is a celebrated author and global educator. Whether she’s interviewing a physician or producing a podcast, her appetite for research, facts, and truth culminates in credible health education and programming that women can rely on. An avid runner, cyclist, and climber, Shannon knows a thing or two about thriving in midlife and lives in Seattle with her cat, dog and boyfriend.

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