Most women in perimenopause will notice changes in their periods. One of the main changes is to the frequency of your cycle. Periods start to reduce and you can go several months without one prior to menopause occurring. This coupled with the assumption that your fertility is decreasing, means that you might assume that you don’t need contraception. Yes, contraception. I’m sure I don’t have to tell you that an unplanned pregnancy at this stage in your life can throw a right spanner in the works! Not even just with regard to the fact that there’ll be no adults-only cruise or long lie-ins at the weekends, but also your health. Pregnancy in your 40’s leaves you at risk of a whole host of complications such as high blood pressure, diabetes and chromosomal problems with the baby. If you’re sexually active and you’re not in the market for a baby, you seriously need to consider your contraception options. What you plump for will very much depend on your circumstances and what your GP advises but I’ve put together a guide below on what options are available. It seems that many of us are enjoying sexual freedom now in our 40’s and 50’s and this is attributed to increased rates of divorce and separation. It’s no big surprise then that STIs are on the increase in this age group. So even if you’ve been sterilised and are not sleeping with a regular partner, you should consider barrier methods of contraception to ensure you don’t catch any nasties.
The male condom
This is a really effective method of contraception. However, there are some men that might find them tricky if they haven’t used them for years and may have difficulties staying erect. Vaginal dryness can also cause discomfort during sex. You can combat this by using a vaginal lubricant but you need to be careful with this as any oil-based lubricant can cause condoms to split and we all know where that can end up…….
The female condom
You might find these awkward to use if you haven’t used them before. However, if you’ve been accustomed to using vaginal cups during your period, you’ll not really have any issues. They are well lubricated, so vaginal dryness shouldn’t be a problem.
The diaphragm and cap
Again, you might find these awkward to use if you haven’t used them before. If you’re suffering from a small prolapse or stress incontinence you might also find them uncomfortable. Spermicides are an inherent part of using a diaphragm and these will provide additional lubrication.
The combined pill
The combined pill can be used safely until you’re 50 as long as you have no conditions or lifestyle factors that are considered a health risk. This includes things such as smoking, obesity, high blood pressure, etc that could lead to heart, stroke or blood clotting problems. Your GP or nurse will be able to advise on this. This pill has loads of advantages for perimenopausal women as it regulates periods, it can help to maintain bone mineral density (which is reduced after menopause), may reduce blood loss and period pains and may also relieve other menopausal symptoms such as hot flushes and night sweats.
The contraceptive patch and vaginal ring
The efficacy, benefits, risks and side-effects with the patch and the ring are similar to the combined pill. They can also be used safely until you’re 50 if you have none of the health risks just mentioned.
All progestogen-only methods can cause irregular bleeding or even no bleeding at all. Not bleeding doesn’t necessarily mean that you’ve arrived at menopause though. It’s just a side effect. If you choose this method and have no bleeding for a long time and suddenly have bleeding, you should see your GP as this can indicate other problems.
The progestogen-only pill (POP or mini-pill)
This pill is suitable for older women and can be used safely until the age of 55.
The contraceptive injection
Another method that can be used until you turn 50. There has been some concern though that the injection might reduce bone mineral density and increase the risk of osteoporosis. If you have any lifestyle or risk factors for osteoporosis (you smoke, have had previous fractures, use steroids, family history, etc) you might want to consider another method. It’s not like there are plenty of others that don’t carry the same risks.
The implant can be used until you’re 50 and there are no worries about loss of bone mineral density with this method.
Intrauterine system (IUS)
The hormone-releasing IUS is not only a highly effective method of contraception but it also significantly reduces the amount of bleeding and period pain. This can be a godsend if you suffer from particularly heavy periods. Also, if you decide to start HRT during perimenopause, the IUS can be used as the progestogen element of HRT. The IUS is licensed for contraception for 5 years but if it is inserted over the age of 45 years it could remain in place for 7 years after discussion with your doctor or nurse. It is only licensed for 4 years if used for HRT but is known to be effective for this purpose for 5 years.
Other contraceptive methods
Intrauterine devices (IUD)
An IUD can cause periods to become heavier or more painful, so it might not be a good option if your periods are already causing a problem. If you have an IUD inserted over the age of 40 it can remain in place, without being changed, until menopause. You should have it removed one year after your periods stop if this is over the age of 50 or two years after periods stop if you’re under the age of 50.
Male and female sterilisation
Sterilisation (both male and female) is the most commonly used contraception method for couples in their 40s. However, it is a surgical procedure and it might not be justified for you if you have low fertility when there are so many other really effective options available.
Natural family planning
If you have already been using natural methods of contraception (timing of periods, changes in cervical mucus and body temperature, etc) you can usually manage to continue to do this until perimenopause. Be warned though, this can be more difficult to maintain once you start having variable cycle lengths and erratic ovulation. It can be even harder to master if you’re new to the technique for the same reasons.
Emergency contraception can be used if you’ve had unprotected sex or if a form of contraception has failed (a split condom or missed pills). There are two forms: the emergency contraceptive pill or the emergency intrauterine device (IUD). There’s no age limit for using emergency contraceptive pills and they are relatively easy to get from your doctor or in pharmacies without a prescription. The emergency IUD has the advantage that it can remain in place and is an effective method of ongoing contraception. The pill, however, would not be recommended to use as your regular form of contraception.
When to stop contraception
You should continue to use contraception for at least one year after your last period if your periods stop after the age of 50, and for two years if your periods stop before the age of 50. This is because sometimes periods might restart even after several months with no bleeding. However, if you are using progestogen-only hormonal contraception you may well only have occasional periods or no periods at all, which makes it difficult to tell if you’re menopausal. These methods can be safely used until you’re 50 (55 for the progestogen-only pill or the IUS). Your doctor might recommend a blood test which would give some guidance as to whether you are menopausal but this is also not definitive. If you’re using combined hormonal contraception you will probably experience regular periods or withdrawal bleeds which again would mask one of the signs of menopause. Blood tests are not reliable and not recommended if you’re using combined hormonal methods.
Hormone replacement therapy (HRT)
The average age for menopause in the UK is 51 but you can experience symptoms in your 40s which might lead you to consider taking HRT. It is important to recognise that HRT is NOT a method of contraception. If you’re still having periods before starting HRT then you will also need to use a method of contraception. Once you start HRT, it can be hard to know when contraception can be stopped because HRT will often give you regular monthly bleeds. It’s best to continue using contraception alongside HRT until you’re 55 as it’s likely you’ll be menopausal by then. If you’re struggling to decide what method might be right for you or you’re having intimacy issues and need support, please get in touch and we can chat about what sort of support might be helpful for you.