Pregnancy can and does occur during the peri menopause. Your likelihood of pregnancy depends on how many eggs you have left and how often you are having sex.

So, when can you safely stop using any contraception? Actually, there is very little scientific evidence to go by.

The ‘Faculty of Sexual and Reproductive health’ (FSRH) has guidelines that healthcare professionals can refer to.

• Between the ages of 40-50 you can stop using contraception if you have not had a period for 2 years.
• Over 50 years old, you can stop contraception after not having a period for 1 year. When I say ‘period’, I mean a natural period, not a withdrawal bleed while on hormone treatment.
• In general, all women can stop using contraception at the age of 55, even if they are still having some periods. After the age of 55, pregnancy is exceptionally uncommon.

Sometimes a ‘FSH’ or ‘follicle stimulating hormone’ blood level can be checked in a woman 50 or over to assess her likelihood of pregnancy, but that wouldn’t be helpful if you’re taking certain hormonal treatments e.g. HRT and the combined pill.

Whatever your situation, please remember HRT is not a contraception.

Contraception during the peri menopause and menopause

Contraception during this transition in your life is an important issue. During the peri menopause and menopause, you can still get pregnant, even if you are taking HRT. When you are over 40 there are more things to consider when deciding which contractive option is best for you. As you get older other health risks increase and this influences the risks and benefits of certain contraceptives. Sexually transmitted diseases are also something to bear in mind. Especially for example if you are in a new relationship.

What type of contraception to use is a joint decision between you and your doctor. Its’ about weighing up the pros and cons, risks and benefits of each choice as well as your personal preferences.

Here are the options:

• Barrier methods e.g. male or female condom and the diaphragm provide good contraception. If they fail usually it’s because of a problem while using them, like a condom splitting.

• The copper coil is very effective at preventing pregnancy. The coil is placed into the womb through the cervix (which sits at the top of the vagina). If this is put in after the age of 40, it can stay in until the menopause.
• There are several progesterone only contraceptives. The ‘mini pill’ contains a low dose progestogen and is very effective if taken correctly. Often it leads to lighter periods or no periods, but some women experience some spotting between periods. This is safe to take until the age of 55.
• The progestogen implant is a small plastic rod placed under the skin of the arm. It lasts for 3 years and is safe to continue until 55.
• The progestogen injection, lasts for 8-13 weeks depending on which type you have. If you are 50 or over you should have a chat with your doctor about whether it’s still the best contraception for you because with increasing age, other health issues which come into play have to be considered, particularly bone health.
• An ‘IUS’ is a coil inserted into the womb which releases progestogen over a period of years. One type is called the ‘Mirena’ coil and can remain in the womb until the menopause if inserted at or after the age of 45. The Mirena can also be used as part of HRT, but in this case would need to be changed every 5 years to keep the lining of the womb thin.
• The combined contraceptive pill contains oestrogen and progestogen. It is not recommended to be used if you are over the age of 50 or if you are younger and have an increased risk of clots or heart disease e.g. if you had a history of clots, smoke, have migraine with aura or over weight. It’s a very effective contraception and can help elevate symptoms of the menopause. On the down side it can reduce libido.

There are also surgical options. Men can have a vasectomy and women a sterilization when the fallopian tubes are blocked or sealed to stop eggs reaching sperm.

This blog post was written by specialist menopause doctor, Dr Emma Ping. You can find Emma on Instagram at @menopausehealthdoctor or on https://menopausecare.co.uk/as...

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