If you’re aged 45 or over, you may be wondering whether you still need to use contraception and what would be a suitable method of birth control for your age group. Whilst fertility does usually decline in the mid-to-late 30s, people in their 40s and 50s do still sometimes get pregnant. Until you reach menopause – meaning you’re over 50 and you haven’t had a period for a year (12 months in a row) – there is a chance you could get pregnant. If that’s something you want to avoid, you should think about using contraception.
Which type of birth control is suitable for you depends on several factors, such as your personal and family medical history, your menstrual cycle, your sexual activity and your preferences. In this article, we will explore some of the best birth control options for older women and some of the benefits and risks of using them.
Why should you take birth control after 45?
“Women who are over the age of 45 and still ovulating should consider using some form of contraception if they do not wish to become pregnant,” says Rhiannon John, sexologist at Bedbible. “However, if a woman has already reached menopause, she generally does not require contraception to prevent unintended pregnancy. Menopause is typically diagnosed when a person aged 50 or above has not experienced menstruation for a consecutive period of 12 months or if they are under 50 and have not had a period for two years. While there is no definitive test for menopause, these are the commonly used criteria to determine its onset.”
There is no test that can tell for certain whether you’re in the menopause and can stop contraception. There is a blood test to measure levels of follicle stimulating hormone (FSH) that can indicate if a woman is becoming menopausal. But this is not a useful test in women over 45 as FSH levels naturally go up and down at this time.
“It’s important to be aware that if you use the combined pill for contraception, you will likely continue to have monthly bleeding as long as you take the pill,” Rhiannon continues. “Additionally, it’s possible for the pill to mask or conceal the typical symptoms of menopause. If you are specifically interested in determining if you are perimenopausal or menopausal while on the combined pill, it would be advisable to consult with your healthcare provider. They can discuss alternative non-hormonal contraception options, such as condoms or a copper IUD, which may allow for a more accurate evaluation of menopausal symptoms.”
The only reliable way to know if you have reached menopause is to look back at your menstrual history. If you have not had a period for a year, you can stop using contraception. However, if you are using hormonal contraception such as the pill, the patch, the ring or the injection, your periods may be affected by the hormones and not reflect your natural cycle. In that case, you may need to stop using hormonal contraception and use a non-hormonal method, such as condoms or a copper IUD, until you are sure you have reached menopause.
What are the best birth control options when you are over 45?
There are many different methods of contraception available in the UK, but some may be more suitable for women in their mid 40s and beyond than others. The type that works best for you will depend on your health and circumstances. Remember that you can always discuss your options with a doctor, sexual health nurse or, in some cases, a pharmacist if you have any queries or concerns.
Some of the factors that may influence your decision include:
- Your risk of pregnancy: some methods are more effective than others at preventing pregnancy. For example, long-acting reversible contraceptives (LARCs), such as implants, IUDs and IUSs, are more than 99% effective and do not require you to remember to use them every time you have sex or every day.
- Your risk of sexually transmitted infections (STIs): some methods, such as condoms, can also protect you from STIs, while others do not. If you have multiple sexual partners, are sleeping with a new partner or are not sure of your partner’s status, you should use condoms in addition to any other method of contraception to reduce your risk of STIs.
- Your medical history: some methods may not be suitable for you if you have certain medical conditions or risk factors, such as high blood pressure, diabetes, heart disease, stroke, breast cancer or blood clots. You should tell your GP or nurse about any health problems you have or medications you take before choosing a method of contraception.
- Your menstrual symptoms: some methods may affect your periods and cause them to be lighter, heavier, change in frequency or stop altogether. Speak to a doctor or pharmacist about how your chosen contraceptive method may affect your period to make sure you’re informed and comfortable with it.
- Your personal preferences: some methods may suit your lifestyle and preferences better than others. For example, some people with uteruses may prefer a method that they can control and stop at any time, while others may prefer a method that they do not have to think about or see. Some may prefer a method that does not involve hormones, while others may prefer one that does.
Here are some of the most common methods of contraception for you to compare.
The combined pill contains two hormones: oestrogen and progestogen. It works by stopping ovulation (the release of an egg) and making it harder for sperm to reach an egg or for an egg to implant in the womb. The combined pill is more than 99% effective if used correctly, you can start or stop it at any time and it does not interrupt sex.
“There are no specific limitations on contraceptive methods based solely on age,” says Rhiannon. “However, certain medical conditions more commonly seen in older women may make some contraceptives less suitable. The combined pill, which contains oestrogen, poses potential health risks such as an increased likelihood of blood clots, cardiovascular issues, and strokes, particularly for women with a history of these conditions. It’s important to note that these risks are specifically associated with oestrogen, not progestogen. To minimise the risks related to oestrogen-containing contraceptives, women can consider non hormonal options and progestogen-only contraceptives as alternative choices.”
The combined pill may also not be suitable for some women and people with uteruses over the age of 35 who smoke or have high blood pressure, and it may increase the risk of certain conditions such as blood clots and breast cancer. Combined hormonal contraceptives are also not recommended for women and people with uteruses who have migraine with aura, and those who who have high blood pressure, cardiovascular disease, a history of stroke, venous thromboembolism (VTE), congenital/valvular heart disease with complications, breast cancer or women and people with uteruses who are aged 50 or older.
The combined pill also does not protect against sexually transmitted infections (STIs) and you have to remember to take it every day. Speak to your doctor if you’re considering taking the combined contraceptive pill so they can look at your individual situation and help you make an informed decision.
This is a pill that contains only progestogen, a hormone that prevents ovulation and thickens the cervical mucus. It can be used by women and people with uteruses who cannot take oestrogen or have other medical conditions that make the combined pill unsuitable. Progestogen only pills can be suitable for over 35s who smoke, and women and people with uteruses who have a higher BMI, who are breastfeeding, have a history of blood clots and are allergic to or do not want to take oestrogen. It is suitable for and well tolerated by many people, but it can cause side effects and it may not be suitable for everyone.
Progestogen-only contraceptives may not be suitable for women and people with uteruses who have breast cancer (or a history of breast cancer) and those with a risk of osteoporosis. It also requires daily use and has to be taken at the same time every day, which some people prefer but others may want something that they don’t have to think about taking regularly. You can buy some progestogen-only pills, like Hana®, over the pharmacy counter or online without a doctor’s appointment, and you will need to fill in a consultation beforehand so the pharmacist can make sure a progestogen only pill is suitable for you.
This is a patch that sticks to your skin and releases oestrogen and progestogen into your bloodstream. It works in the same way as the combined pill, but you only have to change it once a week for three weeks in a row, followed by a patch-free week. It can also make your periods lighter, shorter and more regular, and reduce the risk of ovarian and endometrial cancer. However, it may not be suitable for women over 45 who smoke, have high blood pressure, diabetes, heart disease, migraines with aura or a history of blood clots or breast cancer.
This is a ring that you insert into your vagina and leave in place for three weeks, then remove for one week. It releases oestrogen and progestogen into your bloodstream and works in the same way as the combined pill or patch. It may not be suitable for women over 45 who smoke, have high blood pressure, diabetes, heart disease, migraines with aura or a history of blood clots or breast cancer. It may also cause vaginal irritation, infection, discharge, headaches, breast tenderness or mood changes.
This is an injection that contains progestogen only and lasts for either eight weeks or 12 weeks depending on the type. It prevents ovulation and thickens the cervical mucus. It requires regular visits to your doctor or nurse for injections and some people may experience side effects from the injection, so speak to your doctor or sexual health nurse for more information about whether the injection is the right choice for you.
This is a small rod that is inserted under the skin of your upper arm by a doctor or nurse. It releases progestogen into your bloodstream for up to three years. It prevents ovulation and thickens the cervical mucus. It can cause side effects in some people, so speak to your doctor or sexual health nurse to see if the implant is the right choice for you. It also requires a minor surgical procedure to insert and remove it.
Intrauterine system (IUS)
This is a small plastic device that is inserted into your womb by a doctor or nurse. The IUS is a LARC (long acting reversible contraceptive) and some people may prefer choosing this method as once it’s inserted it will be effective for around 3-6 years and you don’t have to think about it. It releases progestogen into your womb and prevents fertilisation and implantation of a fertilised egg. It can cause side effects in some people and some may find the procedure to get it inserted and removed uncomfortable, so speak to a doctor or nurse about your preferences and options.
Intrauterine device (IUD)
This is a small plastic or copper device that is inserted into your womb by a doctor or nurse. It lasts for up to five to 10 years depending on the type. It prevents fertilisation and implantation of a fertilised egg by creating an inhospitable environment for sperm and eggs. It requires a minor surgical procedure to insert and remove it.
This is a thin latex or polyurethane sheath that covers the penis during sex and collects the sperm. It prevents pregnancy and sexually transmitted infections (STIs). It is easy to use, cheap and widely available. However, it may break, slip off or cause allergic reactions. It also requires cooperation from your partner and has to be used every time you have sex. If you are experiencing vaginal dryness, water based lubricants can help improve the experience. Avoid oil based lubricants, however, as they can make condoms more likely to break.
This is a thin polyurethane pouch that lines the vagina during sex and collects the sperm. It prevents pregnancy and STIs. It is easy to use, cheap and widely available. However, it may be noisy, uncomfortable or difficult to insert. It also requires cooperation from your partner and has to be used every time you have sex.
Natural family planning
This is a method that involves monitoring your body temperature and cervical mucus to identify your fertile days and avoid sex or use another method of contraception on those days. It can help prevent pregnancy without using any hormones or barrier methods. It can also help you understand your body and cycle better. However, it requires daily observation and recording and can be very difficult to be consistent with, and it also requires abstinence or backup contraception on your fertile days. It also may not be reliable if you have irregular cycles, illness, stress or medication that affect your signs.
If you do not want or are done having children, sterilisation is a non-reversible long acting method that can prevent you from getting pregnant. It requires a medical procedure which involves the fallopian tubes being blocked or sealed to prevent the eggs reaching the sperm and becoming fertilised. Speak to a doctor for more information about sterilisation.
“For women in monogamous relationships, another option to consider is a vasectomy for their partner,” says Rhiannon. “A vasectomy is a surgical procedure that involves sealing or cutting the vas deferens, the tubes that carry sperm from the testicles. This procedure is highly effective in preventing pregnancy and is considered a permanent form of contraception for men.”
How do you know when you can stop using birth control?
You can stop using birth control when you have reached menopause and no longer need to prevent pregnancy. However, there is no test that can tell for certain whether you have reached menopause and can stop using birth control. You may have to wait until you have not had a period for 12 months in a row before you can be sure that you are menopausal.
Some methods of birth control can mask the signs of menopause, such as the combined pill, patch or ring, which make your periods regular even if they would naturally stop. Other methods of birth control can cause irregular bleeding or spotting, such as the progestogen-only pill, injection, implant or IUS, which make it hard to tell if your periods have stopped.
If you are using one of these methods and want to know if you are menopausal, you may need to stop using them for a while and see if your periods return or not. You should use another method of contraception during this time if you do not want to get pregnant.
Alternatively, you can ask your doctor for a blood test to measure your levels of follicle stimulating hormone (FSH), which can indicate if you are becoming menopausal. However, this test is not very reliable in women over 45 as FSH levels naturally go up and down at this time.
The best way to decide when to stop using birth control is to talk to your doctor or nurse about your options and preferences. They can help you choose a method that suits you best until you reach menopause.