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?”

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 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 become more irregular. Perimenopause usually begins about 4-8 years before menopause. For most women, perimenopause starts in their 40s, but some women experience perimenopause in their late 30s.

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 50, though some women may go into menopause in their late 40s. Everything after that is post-menopause.

When can I stop using birth control after menopause?

I usually recommend that you use some form of birth control for the first two years after having your last period. But the patch, pill or ring are not recommended as you enter your mid to late 40s. This is due to the high levels of estrogen in these forms of birth control and a 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 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 you’re protected from pregnancy.

Fertility declines with age. You’re far less likely to get pregnant in your 40s and early 50s, but pregnancy can still happen. That means even if you’ve gone a few months without a period, you can still get pregnant. And while it’s rare, some women can ovulate and have a random period. So if you want to prevent pregnancy, it’s better to be on the safe side when it comes to protection.

At what age should you stop taking birth control pills?

I recommend that most women stop taking birth control pills in their early 40s. Birth control pills, sometimes called combination birth control pills, contain estrogen and progestin. Estrogen increases your risk of developing blood clots, high blood pressure or other heart conditions. Other factors like your weight, pre-existing conditions, medical history and whether you smoke can also increase your risk of complications from birth control pills that contain estrogen.

If you’re on the pill, consider talking to your primary care doctor or OB-GYN when you turn 40 to make sure it’s still a safe option for you. If combination birth control pills aren’t recommended, the mini pill might work best – it only contains the hormone progestin, making it safer for women during perimenopause.

Do birth control pills delay menopause?

No, you’ll reach menopause around age 50 whether you’re taking birth control pills or not. But because birth control pills use hormones to create an artificial cycle, they can mask the symptoms of perimenopause and menopause. You’ll continue to have a period as long as you take birth control pills, making it difficult to know if you’re in menopause.

If you’re in your late 40s and aren’t sure if you’ve entered perimenopause, consider stopping your hormonal birth control for a few months. During this time, you can watch for menopause symptoms like irregular periods, hot flashes, night sweats and mood changes. Or you can ask your doctor for a follicle stimulating hormone (FSH) test to see if you’ve entered menopause. You’ll only need to pause your birth control for a month before getting this test.

What can you expect when you go off the pill?

Just as you experienced changes when you started taking the pill, you’ll notice some changes after you stop using it. Many women have irregular periods, the return of PMS symptoms and heavier flows after they stop using birth control pills.

The hormones in birth control pills regulate your period. While on the pill, most women will have their period on a regular schedule. Going off the pill can feel like throwing out the calendar. You may notice missed or late periods, and possibly longer-lasting periods. Eventually, your periods will stop altogether.

Birth control pills can also help lessen PMS symptoms like period cramps, bloating, headaches, fatigue and mood swings.

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.

The biggest benefit of taking birth control pills during perimenopause or menopause is that it keeps you from getting pregnant. You have a chance of getting pregnant as long as you’re still getting your period. Birth control pills are 99% effective at preventing pregnancy when taken as directed.

Birth control pills 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 talk with your primary care doctor or OB-GYN 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. They also increase your risk of high blood pressure, stroke, heart attack, heart disease and breast cancer. This is especially true of patients who have diabetes, smoke, are overweight or have a history of estrogen-dependent cancers.

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.

Are birth control pills considered hormone therapy?

No, birth control pills aren’t used as hormone therapy (HT). The hormones in birth control pills are used to stop ovulation, so they’re at a much higher dose than the amount of hormones you find in HT.

The goal of HT is to get your postmenopausal hormone levels close to what they were before menopause. Typically, lower doses of hormones are used during HT. And the dose of hormones given during each HT session often varies depending on your individual needs.

When should I start talking to my doctor about birth control and menopause?

Some women choose not to see their doctor when they begin experiencing symptoms. Instead, they wait until their annual wellness visit to talk with their doctor about these changes. This is a common, safe approach to managing menopause symptoms.

However, if you experience symptoms that are concerning like heavy, irregular periods, make sure to talk with your primary care doctor or OB-GYN. 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 doctor can help determine what the best options are for you.