March 29, 2013
Dear Mayo Clinic:
I am 44 and would like to discontinue taking birth control pills. Do I need to use another form of contraception if I want to avoid getting pregnant? At what point is it safe to assume that won't happen?
Many women wonder if they need birth control once they are in their 40s. Some actually stop using contraception, believing that they do not need it. That belief is not accurate. Until you are past menopause, birth control is necessary if you do not want to get pregnant.
Menopause is defined as the absence of your menstrual period for 12 months in a row. The average age of menopause in the United States is 51. Ninety-five percent of women go through menopause by age 56.
Contraceptives that use hormones, such as birth control pills, are safe and effective for women of all ages, as long as they do not have risk factors such as smoking or high blood pressure. When used long-term, hormonal contraceptives lower the risk for ovarian cancer and endometrial cancer, a type of cancer that begins in the uterus.
Hormonal contraceptives offer added benefits to women in the years leading up to menopause — a transition known as perimenopause. They can control the hot flashes and night sweats common in up to 80 percent of these women, and reduce heavy bleeding. They also help keep periods regular.
If your desire to stop birth control pills is due to the inconvenience of taking a pill every day, there are hormonal contraceptives that do not require daily attention. One is an implant placed under the skin of the upper arm. Another is a hormonal intrauterine device, or IUD, inserted into the uterus.
Both release a low dose of progestin, a form of the female hormone progesterone. They are very effective in preventing pregnancy. Less than 1 out of 100 women who use these hormonal contraceptives for one year will get pregnant. The implant works for up to three years. The IUD works for up to five years.
One drawback to hormonal contraceptives is that it can be hard to tell when menopause occurs. With these birth control options, you continue to have some bleeding each month, even if you are not ovulating. You may switch to a contraceptive that does not have hormones to see if you have reached menopause. Or, an easier alternative may be to continue hormonal birth control until age 56.
Birth control choices that do not contain hormones include barrier methods, such as condoms, diaphragms, cervical caps, sterilization procedures and natural family planning. A nonhormonal copper IUD is available, too. Although very effective for birth control for up to 10 years, it does not regulate periods or prevent hot flashes.
You should also understand your options for emergency contraception. Emergency contraception is not meant to be used in place of routine birth control. But it is an option if your method of birth control fails, you miss a birth control pill or you have unprotected sex.
In the U.S., emergency contraception is available in pill form and as an IUD. One type of pill which contains progestin can be used up to three days after unprotected sex, while another containing ulipristal can be used up to five days after. The IUD form must be inserted within five days after unprotected sex. These contraceptives do not end a pregnancy that has implanted. Instead, they delay or prevent ovulation.
As you consider birth control options, I strongly recommend you talk with your health care provider. He or she can review the alternatives with you, discuss the benefits and risks of each, and help you make an informed decision about the one that best fits your situation.
— Petra Casey, M.D., Obstetrics and Gynecology, Mayo Clinic, Rochester, Minn.