With all the focus on hot flashes and HT, contraception is often overlooked around the time of menopause, yet it’s really important to prevent an unplanned pregnancy. It may be rare but it can happen! Plus, if you have a new partner or partners you’ll need to continue protecting yourself from potential sexually transmitted infections (STIs) too. Find out everything you need to know about menopause and contraception.
Find what you need quickly
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Can you get pregnant during menopause?
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When can you stop using contraception in menopause?
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How do you know if you’ve been through menopause?
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Do you still need contraception if you are on HT?
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What is the best contraception for menopause?
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Which contraceptives can you use during menopause that don’t depend on systemic hormones?
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Which hormonal contraceptives can you use during menopause?
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Do you need to stop your combined pill at age 50?
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Can you use the contraceptive pill as an alternative to HT?
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Can you use the Mirena IUD for HT?
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Why do you need progesterone in your HT if you are already on the mini pill?
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Can you get sexually transmitted infections (STIs) after menopause?
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Can you use vaginal moisturizers and lubricants with condoms?
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Will contraception affect your periods at menopause?
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Will you need emergency contraception during menopause?
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Final word
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Can you get pregnant during menopause?
Yes! Perimenopause and pregnancy can certainly go hand in hand. Although rare, natural pregnancies can happen well into your 50s, which might not be part of your life plan at this point.
While it’s true that you are at your most fertile early in adult life, as long as your body is releasing eggs there is a chance of getting pregnant. Even if you have irregular or infrequent periods, there is still a chance that an egg has been released.
People are often surprised when asked about contraception as part of a conversation about menopause, but it is still an important part of your healthcare. Pregnancies are riskier in older women, and we see increased rates of miscarriage, gestational diabetes, and pre-eclampsia among other issues. Placental problems also become more common, as does having a baby with genetic problems, including Down’s syndrome.
Having said that, if you are nearing menopause and want to get pregnant then don’t leave it to chance! While it is possible to conceive at this time, it is unlikely without medical intervention. A fertility specialist will be able to explain your options.
When can I stop using contraception in menopause?
You can wave goodbye to your contraception if you meet one of the following conditions:
- You are postmenopausal. In terms of contraception, this means that you are 50 or older and at least one year should have passed since your last period. This only applies if you aren’t on any hormonal medications as these can ‘mask’ the true pattern of your menstrual cycle
- You are 55 or over
- You have had a hysterectomy
Otherwise, you likely need to continue using some method of birth control. If you have a new partner, it is always sensible to use condoms regardless of your menopausal status. This is to help prevent sexually transmitted infections.
How do you know if you’ve been through menopause?
The average age at menopause is 51 with some going through menopause much earlier and others later.
Menopause is generally diagnosed based on your symptoms and bleeding pattern. If you are having typical menopause symptoms, including hot flashes, and you haven’t had a period in over a year, you have likely gone through menopause. Read more about the stages of menopause.
Sometimes it can be more difficult to tell:
- Some hormonal medications, including contraceptives (like the mini pill), can cause periods to stop as a side effect
- Periods can sometimes stop or become less frequent due to certain medical conditions. This means that you may not have been through menopause despite having been period-free for years
Sounds confusing, right? This is the reason that it’s important to check in with your healthcare provider before stopping contraception. They will be able to advise on the best options for your personal circumstances.
Do you still need contraception if you are on HT?
Yes. Although HT contains the same hormones as many contraceptives, the doses are much lower, so it does not work to prevent pregnancy in perimenopause and beyond.
What is the best contraception for menopause?
The ideal contraception in menopause is the method that suits you and your body best! As you approach menopause you may find that changes to your body, such as vaginal dryness, mean you need to swap your usual contraception for something more comfortable or appropriate for you.
Which contraceptives can you use during menopause that don’t depend on systemic hormones?
These include:
- Condoms
- An intrauterine device is known as an IUD. They are particularly useful if you want to avoid taking hormones, or you can’t take them for medical reasons
Condoms
Barrier methods, such as condoms, protect against sexually transmitted infections (STIs) but are not the most reliable contraceptive option. The failure rate is two pregnancies per 100 people per year if used perfectly.
Intrauterine device
Paraguard, the copper IUD
The Paraguard IUD is a small device that sits inside the uterus and works by releasing copper into the uterus and cervix. This alters the cervical mucus and is toxic to sperm. In the unusual event that sperm makes it through and fertilizes an egg and it is more difficult for a pregnancy to implant.
The Paraguard can be fitted by your healthcare provider or at a family planning clinic. In younger women, these provide contraceptive cover for 5 or 10 years depending on the type fitted. If your Paraguard is fitted over the age of 40, it provides contraception until you reach menopause.
It is important to bear in mind that the Paraguard can cause heavier periods. If this is already a problem for you, as it is for many around the time of menopause, you may wish to consider an alternative option.
Mirena and other progesterone-releasing IUDs
This type of IUD l works by slowly releasing progesterone directly into the uterus, this thickens cervical mucus and makes the uterine lining inhospitable for implantation of a fertilized egg.
Be aware that not all progesterone IUDs are created equal. The Mirena is approved as contraception for 8 years from insertion, but other progesterone IUDs are approved for only 3-5 years.
Another advantage of the Mirena is, if you have a Mirena in place and want to use HT, you simply need to add an estrogen gel or patch to complete your treatment plan. A Mirena IUD can be used to provide the progesterone component of your HT for up to five years (at which point a new Mirena would need to be fitted).
Read more about the Mirena IUD or heavy periods during menopause.
Which hormonal contraceptives can you use during menopause?
A wide variety of hormonal contraceptives can be used during your menopause journey. Some of these have the added benefit of making your periods more regular or lighter, although they are not suitable for everyone.
Combined hormonal contraceptives
Combined hormonal contraceptives contain both estrogen and progesterone and can be taken as pills, patches, or vaginal rings.
While combined hormonal contraceptives are reliable and popular, they may not be the best choice as you get older. They are associated with:
- Blood clots (including DVT and PE)
- Cardiovascular disease
- Breast cancer
As your natural risk of these conditions increases with age, the same method that was safe in your 20s may no longer be ideal for use in your 40s.
Current guidance recommends that you should stop combined hormonal contraception, including the combined pill, by the age of 50 for safety reasons.
If you are taking a combined pill in your 40s (or have other risk factors), your healthcare provider may advise you to try switching the type of pill you take. Pills containing progesterone in the form of either levonorgestrel or norethisterone come with a lower risk of causing blood clots. Similarly, pills with a lower dose of estrogen are also thought to minimize risks.
Progesterone-only contraceptives
Progesterone-only contraceptives tend to be much safer than those containing estrogen, especially for those with certain risk factors or those over 50. Options include:
- Progesterone-only pill (referred to as the mini pill or POP)
- Contraceptive injections
- Intrauterine system (including Mirena IUD)
- Contraceptive implants (Nexplanon)
The following points are important to note if you are approaching menopause:
- The contraceptive injection can reduce bone density. As this naturally declines anyway throughout your menopause journey, it is advisable to avoid contraceptive injection after the age of 50 to prevent any additional thinning of the bones. If you are over 40 and still using the injection, your healthcare provider will review you regularly to ensure that you have no extra risks of bone thinning
- The Mirena IUD can be used for contraception until the age of 55 if it is inserted over the age of 45. This is a popular, low-maintenance, and reliable long-term contraception option with the added benefit of tending to make periods lighter
Read Alice’s story about being fitted with a Mirena IUD.
Choosing the right contraceptive during menopause can be quite complicated. Speak to your healthcare provider for help in deciding the best option for you.
Do you really need to stop your combined pill at age 50?
Yes. While the combined pill is a convenient and reliable contraceptive for millions around the world, it does come with certain risks. These include blood clots like DVT and PE, which are up to six times more likely in those taking the combined pill. There is also a small increased risk of breast cancer and potentially stroke and myocardial infarction (heart attack).
While these risks are extremely low in younger women, your background risk increases as you age. For this reason, current guidance suggests that healthcare providers should only prescribe the combined pill ‘with caution’ from the age of 40, and should not prescribe it beyond 50.
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Can you use the contraceptive pill as an alternative to HT?
Yes. If you are aged under 50, the combined pill (containing both estrogen and progesterone) can be used to help with menopause symptoms. It can also help to preserve your bone density. This is because it contains estrogen, the hormone which helps to improve menopause symptoms.
However, while the combined pill can improve some menopause symptoms, HT is generally thought to be safer.
It is also important to note that the combined pill is not suitable for everyone. Check-in with your healthcare provider to ensure it’s the right treatment for you. This particularly applies to those with a personal or family history of breast cancer, heart disease, or blood clots, including DVT or PE.
Find out more about the risks and benefits of HT.
Can you use the Mirena IUD for HT?
In part, yes.
If you still have your uterus, you need to take two types of hormones for HT:
- Estrogen, which helps to ease menopause symptoms
- Progesterone, which protects the uterine lining (endometrium) from the effects of estrogen. These include abnormal thickening and even cancer of the endometrium but are prevented by the use of progesterone
A Mirena IUD can be used to provide the progesterone component of your HT for up to five years (at which point a new Mirena would need to be fitted). This type of IUD works by slowly releasing progesterone directly into the uterus, therefore protecting the uterine lining.
If you have a Mirena in place and want to use HT, you simply need to add an estrogen gel or patch to complete your treatment plan. Let your healthcare provider know if you have a Mirena in place when discussing HT and they will be able to advise.
Be aware that not all IUDs are created equal! While the Mirena contains high enough levels of progesterone to protect your endometrium, there are other IUDs on the market which contain lower doses, or which have not been approved for use in HT. Check with your healthcare provider if you aren’t sure which you have.
Why do you need progesterone in your HT if you are already on the mini pill?
If you are taking a mini pill (which contains progesterone), you may be surprised to hear that this cannot form part of your HT treatment.
This is because the mini pill, contraceptive injection, and implant have not yet been proven to protect the endometrium from the effects of the estrogens found in HT. They are not approved for this use.
If you are happy with the mini pill, you can continue taking it alongside combined HT. That way, you have good contraceptive coverage and appropriate HT. The same goes for the implant and the injection.
Can you get sexually transmitted infections (STIs) after menopause?
Yes. Even if you can stop contraception after menopause, you still need to protect yourself from STIs, especially if you have a new partner or casual partners.
The best way to prevent infection is to use condoms when you have sex, even if you don’t otherwise need contraception. If you are sensitive to latex, try latex-free condoms.
Schedule an STI check if you have a new partner or are in a non-monogamous relationship. This can be done by your regular healthcare provider or at your local sexual health clinic.
Can you use vaginal moisturizers and lubricants with condoms?
Vaginal dryness is very common during menopause and can feel super uncomfortable. Vaginal moisturizers and lubricants can be very helpful but be aware that oil-based products can damage condoms and make them ineffective. Water and silicone-based products do not damage condoms.
Always check the leaflet that comes with your moisturizer or lubricant for information on whether they can be used with condoms.
Will contraception affect your periods at menopause?
Some hormonal contraception can mask the signs and symptoms of menopause.
It can also affect the pattern of your bleeding in the following ways:
- The combined pill or patch tends to give people lighter and more regular periods. Monthly bleeds can continue even after menopause when you use this type of contraception, making it difficult to tell where you are in your menopause journey
- The progesterone-only pill (POP or mini pill) can cause irregular periods and spotting in some users, while others have no periods at all. This can also make it difficult to tell if you have reached menopause
- The Depo injection and intrauterine systems (e.g. Mirena IUD) are similar to the progesterone-only pill. They can cause periods to become lighter or more irregular, although some will have no periods while using these methods
- The copper IUD can cause heavier periods. If this is already a problem for you but you like the idea of an IUD, it might be worth considering a Mirena (which tends to make periods lighter)
It is important to check in with your healthcare provider if you have any heavy, irregular, or unusual bleeding. The same goes for bleeding in between periods or after sex. Your healthcare provider can check if these symptoms are due to your contraception, or if there is another underlying cause.
Will you need emergency contraception during menopause?
The rules for missed pills apply, whether you are menopausal or not. You should consider using emergency contraception if needed.
Final word
While menopause itself gives you plenty to think about, don’t let contraception slip your mind! You need an effective plan to prevent unwanted pregnancies and protect yourself from STIs.
Speak to your healthcare provider to find out the best options for you.
Read more about menopause on our blog or in our symptoms library.
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