Menopause can be a difficult and confusing time for a lot of women. It often comes with several unpleasant symptoms. For example, hot flashes, mood swings and trouble sleeping are a few of the dreaded things you’ve probably heard of.

But when is menopause “over”? When is childbearing really off the table?

“When am I safe to quit using birth control pills?”

As a certified menopause practitioner and midwife at Park Nicollet’s Women’s Center, this is a question I get often.

The answer usually isn’t black and white, as menopause can be very different for every woman. 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 a woman’s hormones begin to change. A woman is still having periods during this time, but they become more irregular.

Menopause is the final period a women has – it’s the curtain closing, so to speak. This is known as when a woman goes 12 months without a period. Everything after that is postmenopause.

When can I stop using birth control after menopause?

I usually recommend that women use some form of birth control for the first two years after having their last period. But the patch, pill or ring are not suggested as women go into their mid to late 40s. This is due to the high levels of estrogen in these forms of birth control and risk of blood clots.

The safest options for women are condoms or vasectomy. But I also suggest an intrauterine device (IUD) during menopause, which can also help with the associated bleeding problems. The mini pill can be used, too. However, if you’re experiencing symptoms of menopause and being treated with the progesterone-only mini pill, it can affect how well it protects from pregnancy.

It’s better to be on the safe side when it comes to protection. Even if you have gone a few months without a period, you can still get pregnant. And, while it is rare, some women can ovulate and have a random period.

Are there any benefits to taking birth control pills during perimenopause or menopause?

Oral hormonal contraceptives like the pill are often the best birth control option for perimenopause symptoms.

They can help regulate periods, reduce bleeding and pain, and help with acne, as well as keep your hormones at consistent levels. So, during perimenopause, this can mean fewer hot flashes. Oral contraceptives can also help maintain bone health and strength.

But I suggest my patients stop taking the pill once they reach menopause. While every woman’s situation is different, there are sometimes risks with staying on the pill. It’s best to consult with your health care provider to help decide what’s best for you.

Are there any risks with taking birth control pills during menopause or perimenopause?

Hormonal contraceptives can sometimes mask symptoms of perimenopause. This can make it difficult to know when you’ve reached perimenopause. And even after menopause, some women can continue to cycle if they stay on hormonal contraceptives.

As mentioned above, I often recommend quitting the pill and similar methods of birth control for women over 40. This is because hormonal contraceptives can increase the risk of blood clots—especially as you age. I suggest patients around their late 40s try hormone therapy instead. The lower dose of estrogen decreases risks, but still provides similar benefits as the pill.

When should I start talking to my health care provider about all of this?

Some women choose not to see their provider when they begin experiencing symptoms. Instead, these women wait until their annual physical exam and address it then.

If you experience symptoms that are concerning, like heavy, irregular periods, make sure to consult your primary care provider. Same thing goes if you feel the symptoms are affecting your quality of life. Menopause is a common, and important, phase of life. And your health care provider can help determine what the best options are for you.