Evidence Used In This Review
We searched MEDLINE using PubMed for English-language articles on contraception in older women published from 1957 to the end of June 2012. Details of our search strategy are given in Appendix 1. We also searched the Cochrane Library using the keyword contraception. Bibliographies of identified articles were manually searched. We also reviewed summary statements and clinical practice guidelines from the US Centers for Disease Control and Prevention, the Society of Obstetricians and Gynaecologists of Canada, and the Faculty of Sexual and Reproductive Healthcare of the Royal College of Obstetricians and Gynaecologists.
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What Does Perimenopause Mean
When your periods stop completely, it’s called menopause. Perimenopause means around the time of menopause. The peri-menopausal years are the few years before your periods stop. The timing of menopause is different for each woman. Although some women stop having periods in their 30s, the average age is the early 50s. So, peri-menopausal women are usually in their 40s or early 50s.
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Other Birth Control Considerations
Dr. Minkin said finding a birth control option that fits your personal needs is what’s key. Your healthcare provider can help you decide which ones will work best for your situation.
“I want to make sure that patients are using something they’re comfortable with and that’s compatible with their lifestyle,” added Dr. Minkin.
If you have multiple partners , you need to use a condom to protect against sexually transmitted infections including chlamydia, gonorrhea, human immunodeficiency virus , and human papillomavirus .
“I’ve had so many young tell me, ‘But I’ve had the HPV vaccine.’ That’s greatI’m delightedbut there are many other out there that it doesn’t protect against,” said Dr. Minkin.
Additionally, even if you use birth control with low failure rates, like IUDs and injections , per the CDC, pregnancy is still possible. If you find that you become pregnant while using birth control methods, contact your healthcare provider as soon as possible.
Current Use Of Female Sterilization The Pill The Male Condom And Larcs Varied By Age
- Among women aged 20 and over, female sterilization increased with increasing age. Roughly 2 in 5 women aged 4049 were relying on female sterilization for contraception compared with 1 in 5 women aged 3039 .
- Pill use generally decreased with increasing age: 19.5% of women aged 1519 and 21.6% of women aged 2029 were currently using the pill compared with 10.9% of those aged 3039, and 6.5% of women aged 4049.
- Condom use was similar among women aged 2029 and 3039 use was lower among women aged 1519 and 4049 . The observed difference between women aged 1519 and those aged 4049 was not statistically significant.
- Use of LARCs was similar among women aged 2029 and 3039 . Compared with these age groups, use was lower among women aged 1519 and 4049 .
Figure 3. Percentage of all women aged 1549 who were currently using female sterilization, oral contraceptive pills, the male condom, or long-acting reversible contraceptives, by age group: United States, 20172019
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What Are The Different Methods Of Contraception Available
Your choice of contraception when you are over the age of 40 years may be influenced by:
- How effective it is.
- Your natural decline in fertility.
- Personal preference.
- If you have a medical condition that needs to be considered.
Many women over the age of 40 will have just the same options available to them as younger women, but may have different priorities. Read the overview of all options in contraception methods. The following information lists the options, linking to individual leaflets, and commenting on any aspects specific to women between the age of 40 and the menopause.
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What Are The Risks And Benefits Of Contraception For Older Women
are an issue for women of all ages, so they must be informed about what works and what doesnt, especially if theyve trusted the same form of contraception for years. It comes as no surprise that women over 40 are still having sex, which comes with the same risks as sexual intercourse among any age group. But as womens bodies change, so do their contraceptive needs and preferences. Fortunately, the number of options available for older women is increasing. Theres a contraceptive option for everyone. Comfort, safety, and preference will help determine your ideal type so that you can enjoy a long and healthy sex life.
What Contraception Can I Use
For women in their 40s no method of contraception needs to be avoided due to age alone.
Once a women reaches 50, combined hormonal contraceptives and the progesterone only injectable contraceptive are not recommended.
The progesterone only pill, progesterone only implant, Mirena IUS, and the copper IUD can all safely be used until the age of 55 when natural loss of fertility can be assumed.
In addition emergency contraception is not limited by age
Some methods of contraception will also provide non-contraceptive benefits, such as period control.
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Are Birth Control Pills Considered Hormone Therapy
No, birth control pills arent used as hormone therapy . The hormones in birth control pills are used to stop ovulation, so theyre 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.
Is The Combined Pill Right For You
The combined pill is safe for lots of people, and unless you have any of the specific issues mentioned later on, the combined pill is probably the best contraceptive pill for you.
The combined pill is the most common type of contraceptive pill and it’s estimated that around 100 million women worldwide use it.
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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 youre 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 womans situation is different, there are sometimes risks with staying on the pill. Its best to talk with your primary care doctor or OB-GYN to help decide whats best for you.
Sex After : Choosing The Right Contraceptive
Women over 40 can enjoy satisfying sex lives, but their go-to form of birth control may need to change.
If youre a woman over 40 who has sworn by the 30-day hormonal pill pack for years, it might be time to reconsider your ideal form of birth control. Your sex life might be the same, but your bodily needs have changed in many ways. The conversation about sexual health and pregnancy tends to revolve around younger women at the most fertile time of their lives, but pregnancy is still possible for women over 40, and they still require contraception to maintain a worry-free sex life. A new study brings these issues to the forefront, exploring the most and least effective forms of contraception for women over 40 and the risks associated with each. Dr. Rebecca Allen of the Warren Alpert Medical School at Brown University and fellow researchers published their findings in the Canadian Medical Association Journal.
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What Can You Expect When You Go Off The Pill
Just as you experienced changes when you started taking the pill, youll 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.
Does The Contraceptive Pill Help With Acne
Generally speaking, combined contraceptive pills are skin-friendly. Yasmin is a popular brand of the combined contraceptive pill, sometimes thought of as being particularly skin-friendly. However, there is evidence to suggest that it carries a higher risk of blood clots in the legs and lungs than older generation combined contraceptive pill brands.
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How Effective Are The Different Methods
The list below shows how effective each of the 15 different methods are, and how often you need to use them or think about them .
The effectiveness of each method is worked out by calculating how many women get pregnant if 100 women use the method for a year.
For example, if a particular contraceptive method is 99% effective, 1 woman out of every 100 who uses it will get pregnant in a year.
Some methods listed below, such as the pill, include the phrase “if used correctly”.
This is because people who use these methods have to use them every time they have sex, or remember to take or apply them every day, week or month.
If the method is not used correctly, it will not be as effective.
Contraceptives that are more than 99% effective:
Contraceptives that are 99% effective if used according to teaching instructions:
- symptothermal method of natural family planning
Contraceptives that are 98% effective if used correctly:
Contraceptives that are 95% effective if used correctly:
Contraceptives that are 92 to 96% effective if used correctly:
- diaphragm or cap with spermicide
Endocrine Changes During The Menopausal Transition
The first sign of imminent onset of the menopause is an elevated level of FSH and decrease in inhibin B in the follicular phase of the cycle . The levels of estradiol and inhibin A which are secreted by the dominant follicle remain normal. The normal intercycle rise in FSH may persist into the follicular phase of the cycle although it is suppressed to normal levels by the time of ovulation. This rise of FSH is associated with lower levels of inhibin B, a hormone which arises mainly from the small antral follicles. The low levels of inhibin B reflect the reduced number of small follicles, which are the major source of this hormone. Recently further evidence to support this hypothesis has been provided from counts of the number of small antral follicles, using high resolution ultrasound, and from the concentration of the more stable anti-Müllerian hormone . The concentration of AMH declines with age and correlates closely with the number of small antral follicles as measured by ultrasound . These endocrine changes probably explain the significant shortening of the follicular phase of the cycle with age and the increased incidence of dizygotic twinning .
Trends in ovarian volume changes and in FSH, inhibin B and AMH concentration also correlate with the time of the final menstrual period .
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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.
Changing Birth Control Needs
The birth control method you used in your 20s or 30s may not be the best option in your 40s and 50s. Your body has changed. Your life has likely changed, too. Now is the time to review contraceptive options with your doctor.
If you donât have sex often, you may want to stop daily or long-term birth control and use condoms or diaphragms instead. Itâs important to note that these are less effective than the pill or long-acting methods.
Not all women in their 40s or 50s need to change the birth control theyâve relied on for years. You may be able to stick with your trusted pill, patch, or ring until menopause. Your doctor will consider your weight, tobacco use, blood pressure, and medical history when you talk about your options.
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Can I Buy Something Similar Cheaper Elsewhere
One of the most common questions that a lot of customers ask is, Can I buy something similar cheaper elsewhere? The short answer is no. When you are looking for a quality birth control for over 40, the most important thing to know is that cheap is not always better. You should carefully research the best birth control for over 40 before buying and consult the prices on some online sales websites to make the best decision.
Preventing Pregnancy In Your 40s
Although fertility tends to decline with age, its possible for many women to get pregnant in their 40s. If youre having sexual intercourse and dont want to get pregnant, its important to use birth control until after youve reached menopause.
If youre confident that you dont want to get pregnant in the future, sterilization surgery offers an effective and permanent option. This type of surgery includes tubal ligation and vasectomy.
If you dont want to undergo surgery, using an IUD or birth control implant is also effective and easy. The birth control pill, shot, skin patch, and vaginal ring are slightly less effective, but still solid choices.
If youre experiencing certain symptoms of menopause, estrogen-containing birth control may provide some relief. For example, the skin patch, vaginal ring, and certain types of birth control pill may help relieve hot flashes or night sweats.
However, estrogen-containing birth control can also raise your risk of blood clots, heart attack, and stroke. Your doctor might encourage you to avoid estrogen-containing options, especially if you have high blood pressure, a history of smoking, or other risk factors for these conditions.
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Do Birth Control Pills Delay Menopause
No, youll reach menopause around age 50 whether youre 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. Youll continue to have a period as long as you take birth control pills, making it difficult to know if youre in menopause.
If youre in your late 40s and arent sure if youve 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 test to see if youve entered menopause. Youll only need to pause your birth control for a month before getting this test.
What Contraceptive Methods Are Used By Women Over 40
The contraceptive methods used by women over 40 years old vary by country .1012 Unlike the United Kingdom and Canada, the United States has a high prevalence of sterilization among older women of reproductive age.10 In other countries, such as the UK, a substantial proportion of women over age 40 use intrauterine devices .11 Oral contraceptives and condoms are also popular among older women in the US, Canada and the UK.12
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