Menopause is a big milestone in every woman’s life. As it approaches, you may experience unpleasant symptoms like hot flashes, mood swings and trouble sleeping. And when menopause arrives, you’ll stop ovulating and getting your period.
But when is menopause “over”? When is childbearing really off the table?
“When am I safe to quit using birth control pills?”
The answer usually isn’t black and white, as symptoms can vary by woman and by age. But here are a few important things to consider when it comes to birth control and menopause.
What’s the difference between perimenopause and menopause?
Perimenopause is menopause’s opening act. It’s the time leading up to menopause when your hormones begin to change. You’ll still have periods during this time, but they can start to change – they can get closer together, further apart, or heavier or lighter. For most women, perimenopause starts in their 40s, but some women experience perimenopause in their late 30s and it can last for several years.
Menopause is the final period you have – it’s the curtain closing, so to speak. When you haven’t had a period in 12 months, you’re in menopause. The average age women experience menopause is around 50, but menopause commonly occurs anytime from late 40s to mid-50s. Everything after that is post-menopause.
Birth control options during perimenopause
If you’re concerned about the health risks of using certain birth controls during perimenopause, the good news is there are several forms of birth control that can be good options. The best one for you can depend on several factors and your doctor or clinician can help you decide.
Combination birth control can be an option for many in perimenopause
The patch, pill or ring are prescription birth control methods that combine estrogen and progesterone hormones. Typically, those who are healthy and nonsmokers, have normal blood pressure and no history of blood clots can use these options, but talk with your primary care doctor, OB-GYN or other women’s health specialist.
Progestin-only birth control is often recommended for perimenopausal women with certain health conditions
Progestin-only contraceptives, like the progestin intrauterine device (IUD), progestin-only pill, or the progestin implant or injection, can be used by those who have more complex medical histories such as a history of uncontrolled high blood pressure.
Nonhormonal or permanent birth control options can also be considered during perimenopause
Nonhormonal options include the copper IUD, barrier contraception like condoms, and spermicides. Fertility awareness (natural family planning) is not recommended with irregular periods and unpredictable ovulation.
Permanent birth control through a tubal ligation or removal of the tubes for women, or a vasectomy for males, can also be good options.
Emergency contraception can be used by perimenopausal women when needed
If emergency contraception is needed for unprotected sex, options include the Plan B One-Step pill, Ella (which requires a prescription), or a copper IUD that must be inserted within five days.
At what age can you safely stop using birth control?
It depends. Overall, it’s important to use contraception through perimenopause if you want to prevent pregnancy.
If you’re using a nonhormonal birth control, are in your late 40s and have reached menopause, you can discontinue birth control.
If you’re using hormonal birth control and are between the ages of 50 and 55, your doctor can help answer questions about when to discontinue the birth control and if hormone testing is appropriate. It’s typically recommended to stop hormonal birth control at age 55 when more than 90% of women have reached menopause.
What are the benefits of using birth control during perimenopause?
The biggest benefit of using birth control during perimenopause is preventing pregnancy. Fertility does decline with age but the unplanned pregnancy rate in women over 40 years old can be up to 75%.
In addition, if you’re using hormonal contraception, you may notice that they can help with the perimenopause symptoms like abnormal bleeding, hot flashes and night sweats.
Are birth control pills considered hormone therapy?
No, hormone replacement therapy (HT) consists of much lower doses of hormones than hormonal birth control and can be used safely by most women. The goal of HT is to manage symptoms of menopause. Hormone dosages vary depending on your individual needs. However, these hormones are not strong enough to stop ovulation like birth control pills do.
Menopause hormones can be added to contraceptives, like the IUD, but can’t be used alone until menopause is confirmed.
Does hormonal birth control delay menopause?
Hormonal contraceptives such as birth control pills do not change the course of menopause but may mask its symptoms. Be sure to check with your provider to help manage menopause symptoms and answer birth control questions during this transitional time.
When should I start talking to my doctor about birth control and menopause?
Plan to talk to your primary care doctor, clinician or OB-GYN annually about continued birth control needs or any questions you may have. If you’re experiencing symptoms that are affecting your quality of life like heavy, irregular periods, schedule a visit with your doctor. Menopause is a common, and important, phase of life, and your doctor can help determine what the best options are for you.
Whether you choose an in-person or video visit, get trusted care from your doctor or clinician through every stage of menopause and beyond.