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Contraception: You Need It Longer Than You May Think


Although fertility falls during perimenopause, women are not fully protected from an unplanned pregnancy until they have reached menopause, which means 12 straight months without a period. Even if you have a few months without a period, you can still get pregnant.

The bottom line is that you need to use an effective, safe, and appropriate method of birth control until menopause is confirmed if you don’t want to get pregnant at midlife.

Many choices for the midlife woman. Perimenopausal women can choose from a number of effective birth control options:

You need to use an effective, safe, and appropriate method of birth control until menopause is confirmed if you don’t want to get pregnant at midlife.

  • Hormonal oral contraceptives, such as combined estrogen-progestogen or progestogen-alone pills
  • Non-oral hormonal contraceptives, delivered by injection, skin patch, or vaginal ring
  • Intrauterine devices (IUDs) with or without hormones
  • Sterilization (tubal ligation or fallopian tube implants for women; vasectomy for men)
  • Barrier methods (diaphragm plus spermicide, spermicide-containing sponge, spermicide alone, male and female condoms), although
    these require disciplined use to be effective.

Natural family planning (the rhythm method) is not recommended for perimenopausal women because irregular periods make predicting ovulation difficult. Emergency contraception (one of the “morning-after” pills that actually can be used up to 72 hours after intercourse) is also available to provide backup after a contraceptive failure, but it is not recommended as regular birth control.

Remember that only one form of birth control—condom use—provides some protection against HIV and other sexually transmitted infections.

Special considerations for hormonal contraceptives. There are several things about hormonal contraceptive use that are particularly pertinent for perimenopausal women:

  • Hormonal oral contraceptives can provide a number of benefits for perimenopausal women beyond preventing pregnancy. These benefits, listed in the table at the bottom of the page, may also apply to non-oral hormonal contraceptives, although more study is needed to be sure.
  • In addition to potential benefits, use of hormonal contraceptives by perimenopausal women has been associated with an increased risk of blood clots and may be associated with some increase in the risk of heart attack, stroke, and breast cancer.
  • Perimenopausal women should not use estrogen-containing contraceptives if they smoke or have a history of estrogen-dependent cancer, heart disease, high blood pressure, diabetes, or blood clots. Otherwise, hormonal contraceptives appear to be safe for healthy women over age 35, provided they do not smoke.
  • Taking hormonal contraceptives can mask signs of approaching menopause, including menstrual irregularities. This can make it difficult to know when perimenopause is occurring.
  • Use of any combination estrogen-progestogen contraceptive will result in withdrawal bleeding (ie, bleeding like a menstrual period) even after menopause.
  • Some providers tell women to stop hormonal contraceptives at age 51 (the average age when menopause occurs), but this strategy is not always appropriate, since not all women will have reached menopause by that age and will still need birth control.

Benefits of hormonal oral contraceptives beyond birth control
More regular menstrual cycles
Reduced menstrual bleeding (and lower rates of iron deficiency anemia as a result)
Decreased uterine pain during menstruation
Decreased risk of ovarian and uterine cancer
Reduced hot flashes
Maintenance of bone strength
Improvements in acne (which can flare up around menopause)
 
Adapted from Menopause Practice: A Clinician’s Guide, 4th ed. Copyright 2010, 
The North American Menopause Society.
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