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Women’s Wellness: Do I still need birth control?
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Birth control is often something women, perhaps in their forties or early fifties, stop worrying about a little too soon. Mayo Clinic gynecologist Dr. Petra Casey says, "We find that in most of the research, by the time a woman reaches the age of 55, she is 95 percent likely to have gone through menopause. Menopause is defined as one year of no periods. If you reach 11 ½ months of no periods, then have a period, the clock starts all over again and you’re still not in menopause."
The article below is written for the Office of Women's Health by Dr. Casey.
Do I still need birth control?
Wondering when you’re menopausal and can safely stop birth control? What birth control is best for women over age 35 or 40? Can you still get pregnant in your 40s and 50s? These are common questions women ask of their gynecologists, women’s health physicians and other health care providers.
Overall, almost half of all pregnancies and 75 percent of pregnancies in women over 40 years of age are unplanned. 1,2 Also, some pregnancy complications and risk of miscarriage go up with age. So, if you don’t want to become pregnant, using effective birth control until you are truly menopausal is very important.
Watch: Dr. Casey discusses birth control for women approaching menopause.
Journalists: Broadcast-quality sound bites with Dr. Casey are in the downloads.
Depending on your medical history, your health care provider will talk with you about the best options for you. If you are at a healthy weight, don’t smoke, don’t have high blood pressure or history of blood clots, you can probably continue the oral contraceptive pill, patch or ring well into your 50s. 3
Other great options which don’t contain the hormone estrogen include IUDs, implants, shots and minipills. Some IUDs contain the hormone levonorgestrel, a kind of progestin, which helps decrease or even eliminate heavy menstrual bleeding, a common problem for women in their 40s. These types of IUDs last 3 to 5 years. Another kind of IUD is made of copper, does not contain hormones and can last up to 10 years. Both types of IUD and the contraceptive implant, a small flexible rod which is inserted under the skin of your arm for 3 years of birth control, are collectively called long-acting reversible contraception (LARC). They are more effective than pills, patch or ring, don’t contain the hormone estrogen (so women who cannot use estrogen can use these), and can protect you against pregnancy for several years. 4
Just in case you had unprotected sex and you don’t wish to become pregnant, there are also several kinds of emergency contraception, previously known as the morning after pill. There are pills called Plan B One-Step which you can get at your local pharmacy without a prescription. They contain the hormone levonorgestrel and delay ovulation or release of an egg. They do not interfere with an established pregnancy or cause a miscarriage. Plan B should be taken as soon as possible after unprotected sex but must be taken within 72 hours. Another option which is more effective, especially if you are heavier, is Ella. Ella is effective in decreasing the risk of pregnancy up to 5 days after unprotected sex but requires a prescription. A copper IUD inserted within 5 days of unprotected sex is the most effective option for emergency contraception but requires an appointment with a health care provider. The advantage of the IUD is that you can keep it for birth control for up to 10 years (and about 80% of women do). 5
Once you have missed your period for a year, you are considered menopausal and may safely stop birth control. About 90-95% of women will be menopausal by age 55 and may stop birth control then. Sometimes lab tests are also performed to confirm menopause, but most women don’t need them. Even before the final period, many women experience menopausal symptoms such as hot flashes and trouble sleeping. You can start on menopausal hormone therapy using an estrogen patch to help manage symptoms and use one of the progestin-only birth control options for contraception and to protect the uterine lining from growing too much with the estrogen. The progestin-containing IUD, implant, shot or minipill all work well for this. If you have had a hysterectomy, you can take estrogen alone. 6 If you would like to avoid hormones as you transition into menopause, you can use the copper IUD, barrier methods like condoms, cervical cap, diaphragm or sponge, or have a minor surgical procedure to tie or block your fallopian tubes. Your health care provider can help guide you in choosing the best birth control option for you during the menopausal transition.
References:
- Finer LB,. Zolna, MR Declines in Unintended Pregnancy in the United States, 2008–2011.N Engl J Med 2016; 374:843-852March 3, 2016DOI
- Shifren, JL, Gass, ML, for the NAMS Recommendations for Clinical Care of Midlife Women Working Group. The North American Menopause Society Recommendations for Clinical Care of Midlife Women Menopause: The Journal of The North American Menopause Society Vol. 21, No. 10
- ACOGCommittee Opinion no. 450: Increasing use of contraceptive implants and intrauterine devices to reduce unintended pregnancy.American College of Obstetricians and Gynecologists Committee on Gynecologic Practice.; Long-Acting Reversible Contraception Working Group..Obstet Gynecol. 2009 Dec;114(6):1434-8
- Zhou, L., Xiao, B. Emergency contraception with Multiload Cu-375 SL IUD: a multicenter clinical trial.Contraception. 2001;64:107–112
- Long ME, Faubion SS, MacLaughlin KL, Pruthi S,Casey PM. Contraception and hormonal management in the perimenopause. J Womens Health (Larchmt). 2015 Jan;24(1):3-10.
