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MenoPause Blog

Contraception for Perimenopausal Women

by JoAnn Pinkerton | Dec 05, 2016

We're pleased to have a guest post from Dr. Andrew Kaunitz.

Andrew Kaunitz, MD, NCMP

NAMS Board Member

Much confusion surrounds contraception (birth control) for perimenopausal women. Before getting started with specific methods of contraception, let’s start with a few definitions:

  • Menopause refers to the permanent cessation of menstruation; the average age of menopause is approximately 52 years.
  • Perimenopause refers to the years of transition from regular menstrual cycles to menopause. The transition tends to begin sometime between a woman’s mid-40s and her early 50s. For most women, the first sign of perimenopause is that menstrual cycles become less predictable; skipped cycles or more frequent cycles are common. A second common symptom of perimenopause is the occurrence of hot flashes and night sweats that may come and go.

Although the likelihood that a perimenopausal woman might become pregnant is lower than for younger women, pregnancy can and does occur in women who are in the of this transition phase. Few of my perimenopausal patients wish to become pregnant. Furthermore, pregnancy in women in their late 40s or early 50s is often associated with increased health risks for the mother and the baby. For these reasons, contraception is important for perimenopausal women.

Although barrier contraceptives such as condoms are notoriously ineffective for younger women, perimenopausal women who are motivated to use condoms consistently may have more success with this over-the-counter contraceptive method compared with their younger counterparts. After all, as we get older, we become more disciplined regarding many activities, and that can include condom use.

Another factor reducing the failure rate of condoms in perimenopausal women is that women undergoing the transition are less fertile than younger women. In addition to birth control, condoms protect women against sexually transmitted infections. Having acknowledged that perimenopausal women can use condoms effectively, I must also acknowledge that few of my patients in the transition are interested in using this approach to birth control.

What about birth control pills (which contain estrogen and progestin)? Although many women believe that the pill should not be used for more than 5 to 10 years, in fact, there is no time limit applicable to duration of pill use. Furthermore, use of the pill (along with the birth control patch and vaginal ring) has particular benefits for perimenopausal women. The irregular bleeding and hot flashes that commonly accompany the transition are prevented by using the pill, patch, or ring. In addition, the decline in bone mineral density often associated with perimenopause is prevented by use of the pill. Finally, perimenopausal women who use the pill long term will experience a significantly lower risk of ovarian and uterine (endometrial) cancer.

It is important to be aware, however, that some perimenopausal women cannot safely use the pill, patch, or ring (each of these methods contain estrogen and progestin). Specifically, older reproductive-aged women who smoke; have hypertension, diabetes, or migraines; or are obese should not use these estrogen-containing methods of birth control.

Older reproductive-aged women who are doing well on the pill can continue until menopause. Rather than checking hormone levels, a practical approach is to continue until age 55. At that time, the likelihood of menopause is very high, and then a woman can simply stop the pill, or if she prefers, transition to hormone therapy.

In the last decade, more and more US women who are using contraceptives are using intrauterine devices (IUDs) and the contraceptive implant—these methods are more effective and convenient than condoms or the pill. Furthermore, because IUDs (hormone-releasing models as well as a copper IUD are available) and the implant do not contain estrogen, they can be used by women who are not good candidates for the pill, patch, or ring.

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JoAnn V. Pinkerton, MD, NCMP
Executive Director


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