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Contraception during perimenopause and menopause

If you don’t want to get pregnant in the perimenopause, you need to use contraception. Contraception not only prevents pregnancy, but it can also help with menopausal symptoms. You might find that the best method for you during the perimenopause may be different to the one you usually use.

Can I still get pregnant?

You can still get pregnant until you reach the menopause (one year after your periods have stopped) or the age of 55, whichever comes first.  

So, if you are in the perimenopause and don’t want to get pregnant, it’s important to use contraception even if your periods are irregular and only come every few months. 

It’s advised that, if you are under 50 but have reached menopause, you use contraception for two years after your last period.  

If you’re unsure if you’re still fertile, speak to a healthcare professional before you stop using contraception.  

You can get an STI at any age so make sure you use condoms and test regularly and when you have sex with someone new. 

Get tested for STIs

Things to consider

When thinking about contraception during the perimenopause there are a few things you need to discuss with a healthcare professional about the method you’re currently using or one you want to start: 

  • HRT (hormone replacement therapy) is not compatible with all contraceptive methods so if this is something you are planning on using, some methods will not be recommended. The Mirena coil can also be used as the progestrogen element of HRT 
  • Some health conditions or risk factors can mean certain methods are unadvisable 
  • Your age may limit the methods available to you 
  • You may be able to use contraception to help with your perimenopause symptoms 

It’s useful to understand more about the different methods and how they interact with the perimenopause while exploring your options.  

Hormonal methods

Combined Methods

  • What are they? Combined methods contain progesterone and oestrogen. They include the combined pill, vaginal ring and the patch
  • What benefits can they have? The oestrogen in these methods can help with hot flushes and other menopausal symptoms and they can help improve bone density which declines during the perimenopause.  
  • Can they be used with HRT? These methods cannot be used at the same time as HRT as the hormone levels in these methods are much higher. But they can act as a replacement for HRT as they can help with symptoms.
  • Who can use them? You can use these methods until the age of 50 if there you have no health risks which you should discuss with a healthcare professional. 

After the age of 50, it’s not recommended to continue using the combined methods as they can increase your risk of blood clots. 

With combined methods you will continue to get a withdrawal bleed that looks like a period which can make it hard to know when you’ve reached the menopause. However, the blood test that is sometimes given to help determine if you are still fertile will not be accurate if you are using combined methods.  

Progestogen-only methods

  • What are they? Progestogen-only methods include the injection, the implant, the progestogen-only pill, and the hormonal coil (LNG-IUC). Unlike the combined methods, they don’t contain oestrogen.
  • What benefits can they bring? These methods are a good option if you have heavy periods which can be a symptom of perimenopause as it’s common to get no bleeding or light, infrequent bleeding. 
  • Can they be used with HRT? Progestogen-only methods can be used safely with HRT and the Mirena coil (a type of hormonal coil) can be used as a form of HRT. 
  • Who can use them? You can take progestogen-only methods if you have certain health conditions or risk factors that mean you can’t use combined contraception methods.  

As you don’t get a period with these methods (although you may get some bleeding) it can be hard to know when you’ve reached the menopause.  

If you’re not sure and are using a progestogen-only method, you may be able to take a menopause test at your GP surgery that will measure the levels of follicle-stimulating hormone (FSH) in your blood. This is not 100% reliable, particularly if you’re over 45.

The progestogen-only pill is taken everyday. It is safe to use at any age.  

More about the progestogen-only pill

The injection is a long-acting reversible contraception that means you don’t need to think about it every day.  

The injection can affect some people’s bone density. This is usually not long-term but as your bones thin as you get older this may be worth discussing with a healthcare professional. For this reason, the injection may not be recommended to you if you have any risk factors or if you are over 50.  

More about the injection

The implant is a long-acting reversible contraception that means you don’t have to think about it every day. The contraceptive implant is safe to use at any age.  

More about the implant

The hormonal coil is a small, T-shaped plastic device that once fitted by a specially trained doctor or nurse, prevents pregnancy for 3-5 years. The hormonal coil is safe to use at any age and is particularly good at helping with heavy, painful periods.  

The Mirena coil is the only method that can be used as a form of HRT as well as contraception. If the Mirena coil is being used for HRT, it will need to be replaced every five years. If being used solely as contraception, it is possible to keep the coil in for longer than the five years, sometimes up to 10 years depending on your age. Your healthcare professional will be able to advise. 

More about the hormonal coil

Non-hormonal methods

  • What are they? Barrier methods and the copper coil are all methods that don’t contain hormones. 
  • What benefits can they have? Non-hormonal methods won’t interfere with your hormone levels meaning you will be able to tell when you enter perimenopause and then menopause. They won’t cause any hormonal side effects but also can’t help with menopause symptoms. 
  • Can they be used with HRT? As they don’t contain hormones they are safe to use with HRT.

The copper coil (cu-IUC) is a small T-shaped device inserted into the uterus by a trained professional. Copper coils can last up to 10 years and can be left in place until after the menopause if fitted after the age of 40. If you suffer from heavy periods, this may not be the method for you as it can cause periods to become heavier or more painful. 

More about the copper coil

You can continue to use condoms as you would before perimenopause but if this is your chosen method of contraception, it’s really important you use one every time you have sex even if your periods are very irregular as it can be hard to predict when your next ovulation will be.  

A common symptom of perimenopause is vaginal dryness – to help, use lube or buy lubricated condoms. Don’t use oil-based products with condoms as it can cause them to split. 

More about condoms

Caps and diaphragms are silicon domes that are inserted into the vagina before sex and kept in until 6 hours after sex. They can be used at any age but if you suffer with weak pelvic floor muscles or overactive bladder, which can be common during the perimenopause, these may be more uncomfortable to use.  

More about caps and diaphragms

Also known as natural family planning, this method involves tracking your temperature, cycle and other fertility signs to predict your fertile days. This is not recommended during the perimenopause if you don’t want to get pregnant as irregular periods make it hard to predict when your fertile days are.  

More about the fertility awareness methods

Tubal occlusion or vasectomy are permanent contraception methods. You can get these at any point. There are often long waiting lists for these surgical contraception methods and you will need to use other contraception in the meantime. For this reason, many people use LARC methods such as the hormonal coil which has the same effectiveness at preventing pregnancy but is less invasive and easier to access.  

More about sterilisation More about vasectomy

Which methods can I use if I’m on HRT?

afe to use with HRT are: 

The Mirena coil is the only method of contraception that also acts as HRT. You can use this method as the progestogen element of your HRT so you only need to take the oestrogen part.

Can HRT be used as contraception?

The hormone levels in HRT are too low to act as contraception so you will still need to use contraception during the perimenopause. The levels of oestrogen and progestogen found in HRT is not enough to prevent ovulation. One option is to have the hormonal coil fitted as your contraception method, this can then also be used as the progestogen element of your HRT.   

Can hormonal contraception delay menopause?

Hormonal contraception cannot delay the menopause but the hormones in these methods might mask or help manage your symptoms so you could enter the perimenopause or menopause without realising. For example, you may still get regular bleeding, but this doesn’t mean you are ovulating each month (remember a withdrawal bleed is different to a period). As irregular periods are a key indicator of perimenopause, you won’t know when you’ve entered this stage.

Can I still use emergency contraception?

Yes, you can still use emergency contraception if you have had sex without contraception or you think that your contraception may have failed. This will not be affected by your HRT. If your periods are still regular, you can use our risk of pregnancy calculator to work out the likelihood of pregnancy.  

More about the emergency contraceptive pill
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