- When Women Can Stop Using Contraceptives
- Your Birth Control Should Probably Change as You Get Older—These Are the Best Options in Your 20s, 30s, and 40s
- Sex After 40: Choosing the Right Contraceptive
- What Are the Risks and Benefits of Contraception for Older Women?
- Why Is This Study Important?
- Additional Resources:
- Contraception Options for Women Over 40
- Young man opening a condom
- When can I use contraception again after having a baby?
- How effective is contraception?
- Where can I get contraception?
- Stopping contraception
- Perimenopause and menopause—what’s the difference?
- When can I stop using birth control after menopause?
- Are there any benefits to taking birth control pills during menopause or perimenopause?
- Are there any risks with taking birth control pills during menopause or perimenopause?
- When should I start talking to my health care provider about all of this?
- Perimenopause and Birth Control
- Efficacy Levels in Birth Control
- Permanent vs. Temporary Birth Control
- Other Health Concerns
When Women Can Stop Using Contraceptives
- Contraceptive protection is still needed for women aged >44 years if the woman wants to avoid pregnancy.
Comments and Evidence Summary. The age at which a woman is no longer at risk for pregnancy is not known. Although uncommon, spontaneous pregnancies occur among women aged >44 years. Both the American College of Obstetricians and Gynecologists and the North American Menopause Society recommend that women continue contraceptive use until menopause or age 50–55 years (333,334). The median age of menopause is approximately 51 years in North America (333) but can vary from ages 40 to 60 years (335). The median age of definitive loss of natural fertility is 41 years but can range up to age 51 years (336,337). No reliable laboratory tests are available to confirm definitive loss of fertility in a woman. The assessment of follicle-stimulating hormone levels to determine when a woman is no longer fertile might not be accurate (333).
Health-care providers should consider the risks for becoming pregnant in a woman of advanced reproductive age, as well as any risks of continuing contraception until menopause. Pregnancies among women of advanced reproductive age are at higher risk for maternal complications, such as hemorrhage, venous thromboembolism, and death, and fetal complications, such as spontaneous abortion, stillbirth, and congenital anomalies (338–340). Risks associated with continuing contraception, in particular risks for acute cardiovascular events (venous thromboembolism, myocardial infarction, or stroke) or breast cancer, also are important to consider. U.S. MEC states that on the basis of age alone, women aged >45 years can use POPs, implants, the LNG-IUD, or the Cu-IUD (U.S. MEC 1) (5). Women aged >45 years generally can use combined hormonal contraceptives and DMPA (U.S. MEC 2) (5). However, women in this age group might have chronic conditions or other risk factors that might render use of hormonal contraceptive methods unsafe; U.S. MEC might be helpful in guiding the safe use of contraceptives in these women.
In two studies, the incidence of venous thromboembolism was higher among oral contraceptive users aged ≥45 years compared with younger oral contraceptive users (341–343); however, an interaction between hormonal contraception and increased age compared with baseline risk was not demonstrated (341,342) or was not examined (343). The relative risk for myocardial infarction was higher among all oral contraceptive users than in nonusers, although a trend of increased relative risk with increasing age was not demonstrated (344,345). No studies were found regarding the risk for stroke in COC users aged ≥45 years (Level of evidence: II-2, good to poor, direct).
A pooled analysis by the Collaborative Group on Hormonal Factors and Breast Cancer in 1996 (346) found small increased relative risks for breast cancer among women aged ≥45 years whose last use of combined hormonal contraceptives was <5 years previously and for those whose last use was 5–9 years previously. Seven more recent studies suggested small but nonsignificant increased relative risks for breast carcinoma in situ or breast cancer among women who had used oral contraceptives or DMPA when they were aged ≥40 years compared with those who had never used either method (347–353) (Level of evidence: II-2, fair, direct).
Your Birth Control Should Probably Change as You Get Older—These Are the Best Options in Your 20s, 30s, and 40s
Whether you’re 15 or 50, one rule remains the same: If you haven’t hit menopause and you don’t want a baby, then you need some kind of birth control.
But that doesn’t mean you should stick with the same method for all of your fertile years. In fact, it’s often wiser to make some changes along the way. The best pick for you today might no longer be a winner in a few years, and if you haven’t thought about your contraception in a while, it could be time for an update. So what’s the ideal option for you right now?
To make your selection, you and your doctor should discuss a number of factors, including your age. Age is important both because of certain health issues and risk factors as well as because your lifestyle habits tend to change, Mary Jane Minkin, MD, clinical professor of obstetrics and gynecology at Yale University School of Medicine, tells Health. Here’s a guide to getting smarter about birth control in your 20s, 30s, and 40s.
RELATED: 7 Health Benefits of Birth Control Nobody Talks About
In your 20s…
The Pill is a popular pick at this age, and it might be ideal for you—or maybe not. Many 20somethings live a hectic lifestyle, notes Dr. Minkin. “Can you remember to take a pill every day? That’s the major question,” she says. “If you look at the scientific literature, you’ll see that the average number of forgotten pills can be as high as 4 per month!” Each missed pill further reduces the efficacy of this method, so skipping several is pretty risky if you’re trying to avoid getting pregnant.
Fortunately, the Pill isn’t your only option. “I have a patient, a very smart girl who’s a college student, who just can’t remember to take the Pill, so every 3 months she comes in for a Depo-Provera shot instead,” says Dr. Minkin. (Depo-Provera relies on the hormone progestin to thicken cervical mucus so sperm can’t get to an egg.)
For other young and busy women, NuvaRing might work well. This hormonal method requires you to insert a ring and remove it after 3 weeks, which might be less of a hassle than taking an oral med every day. The catch: “You have to be comfortable touching your vagina,” says Dr. Minkin. If the idea of inserting a ring makes you squeamish, it isn’t for you. (The FDA just approved a vaginal ring called Annovera that can be used for a full year, but it likely won’t hit pharmacy shelves until 2019 or 2020.)
RELATED: How Many Times Can You Actually Take Plan B? Asking for a Friend
Also worth remembering: If you have multiple partners, you need to use a condom every time to protect against sexually transmitted infections (STIs), even if you’re using hormonal contraception. “I’ve had so many young women tell me, ‘But I’ve had the HPV vaccine!’ That’s great—I’m delighted—but there are many other out there that it doesn’t protect against,” says Dr. Minkin.
In your 30s…
If you’re happy with the method you were using in your 20s, you might be able to stay with it, but there are some important caveats. “If you’re over the age of 35 and you’re a smoker, you shouldn’t be taking birth control pills,” says Minkin. Ditto for rings and patches, because the hormones will raise your risk of a heart attack, stroke, or blood clot. These risks exist for non-smokers and younger smokers, too, but are much lower.
Whether you’re a smoker or not, one method you may want to consider in your 30s is an IUD. Although you can get an IUD at any age, they’re most popular in the U.S. among women who’ve finished having children or who don’t plan to get pregnant again for a while. Once you’ve given birth, your cervix has been stretched out, so insertion tends to be less painful than if you haven’t had a baby—though most women (including those who’ve never had kids) can just take an OTC painkiller before the procedure and feel fine, says Dr. Minkin.
The two most commonly used IUDs are the Mirena (which releases a small amount of progestin and can stay in for at least 5 years) and ParaGard (which is made of copper and can stay in for at least 10 years). Dr. Minkin says IUDs have become increasingly popular, and she’s seen a surge of interest in her practice since President Trump got elected. “Contraceptive coverage is up in the air, along with funding for Planned Parenthood,” she explains. “IUDs are covered for now and can stay in for 5 to 10 years.”
And again, if you have more than one partner, a condom—with or without another form of contraception—is a must.
RELATED: 6 Ways Your Breasts Change When You Reach 40
In your 40s…
You’ve probably heard that your fertility takes a nosedive in this decade, and that’s generally true. But there are also plenty of “surprise” pregnancies among women in this age group. “I have personally delivered babies for three women who were 47 years old and not trying to get pregnant!” says Dr. Minkin. You’re not in the clear until you’ve gone a full year without a period.
If you’re dealing with symptoms of perimenopause like hot flashes, night sweats, and irregular periods and you aren’t a smoker, then low-dose birth control pills might be a good bet. “I use them a lot for women in their early- to mid-40s, because it helps control their symptoms,” says Dr. Minkin.
Concerned about your breast cancer risk, which starts to rise in your 40s? Some research has suggested that hormonal birth control might further raise the chances of the disease, though Dr. Minkin isn’t too concerned. (She says any increase appears to be minimal.) Still, if you’re worried—perhaps because you also have a family history of breast cancer or other risk factors—then consider the copper IUD. “If your periods are regular and you just want reliable contraception, ParaGard is fabulous and there are no hormones,” says Dr. Minkin.
RELATED: What It’s Like to Get Nexplanon, the Birth Control Implant in Your Arm
The contraceptive sponge, which is back on the market, might also be a good pick for some women in this age group. “I don’t want a teenager using it exclusively, but if you’re 48 years old and you’ve gone 9 months without a period, the chances of you getting pregnant are pretty darn small,” says Dr. Minkin. “So if you want to stop the method you were using before for whatever reason and use the sponge now, that’s fine.”
Of course, if you have multiple partners—maybe you’re starting to date again after a long hiatus—you still need to use condoms, because you can get an STI at any age.
No matter how old you are, Dr. Minkin says finding a birth control method that fits your personal needs is really what’s key. “I want to make sure that patients are using something they’re comfortable with and that’s compatible with their lifestyle,” she says.
Sex After 40: Choosing the Right Contraceptive
If you’re a woman over 40 who has sworn by the 30-day hormonal pill pack for years, it might be time to reconsider your ideal form of birth control. Your sex life might be the same, but your bodily needs have changed in many ways.
The conversation about sexual health and pregnancy tends to revolve around younger women at the most fertile time of their lives, but pregnancy is still possible for women over 40, and they still require contraception to maintain a worry-free sex life.
A new study brings these issues to the forefront, exploring the most and least effective forms of contraception for women over 40 and the risks associated with each. Dr. Rebecca Allen of the Warren Alpert Medical School at Brown University and fellow researchers published their findings in the Canadian Medical Association Journal.
What Are the Risks and Benefits of Contraception for Older Women?
Because the medical risks of pregnancy increase with age, contraception for women over 40 is just as immediate a concern as it is for younger women. There are risks and benefits associated with each form of contraception, especially in conjunction with women’s changing bodies.
“Clinical judgment will be required to balance the risks and benefits when a woman has multiple medical conditions,” Allen says. “The availability of safe, effective options suggests that estrogen-containing methods should increasingly be used with caution in older women who have cardiovascular risk factors.”
This is particularly true for oral contraceptives, which can also prove less effective for women as they grow older. The risks of oral contraceptive use in women over 40 include cardiovascular complications, such as blood clots, and bone fracture risks.
But the benefits can’t be overlooked, either. Women who use oral contraceptives generally enjoy menstrual regularity, regulation of vasomotor symptoms, such as hot flashes and night sweats, and a decrease in the risk of endometrial cancer. The researchers suggest non-hormonal and progestin-only birth control methods for women who have been advised to avoid contraceptives containing estrogen.
According to the study, the World Health Organization names copper intrauterine devices (IUDs), progestin implants, and sterilization as the most effective forms of birth control. The ideal for women over 40 is generally long-acting, reversible contraception, such as an IUD. This does not discount the effectiveness of short-term methods, such as oral contraceptives, but these options should be assessed on an individual basis.
In addition, while there are women over 40 who are able to conceive without complications, all women should be aware of the possible consequences. As the report states, “he risk of spontaneous abortion and chromosomal abnormalities increases markedly after age 40. Older age is also associated with an increased risk of obstetric complications, including gestational diabetes, hypertension, placenta previa, cesarean delivery, perinatal death, and maternal death.”
Why Is This Study Important?
With so many birth control options, choosing the most age-appropriate form of contraception can be challenging. Unintended pregnancies are an issue for women of all ages, so they must be informed about what works and what doesn’t, especially if they’ve trusted the same form of contraception for years.
It comes as no surprise that women over 40 are still having sex, which comes with the same risks as sexual intercourse among any age group. But as women’s bodies change, so do their contraceptive needs and preferences. Fortunately, the number of options available for older women is increasing.
There’s a contraceptive option for everyone. Comfort, safety, and preference will help determine your ideal type so that you can enjoy a long and healthy sex life.
- Which Birth Control is Right For You?
- Choosing the Right Birth Control
- The Health Risks of Pregnancy
Contraception Options for Women Over 40
There’s no question that 40 is a milestone birthday. It’s a midlife point—a time to reflect, evaluate, consider, think. Is this the right career for you? Are you happy in your marriage or relationship? How are your children turning out? Is it time to have children?
But as you muse upon the course your life has taken up to now and where you want it to go over the next decade, don’t forget to consider one very important component: contraception.
Whether you’re finished having children or considering having your first one (don’t laugh: birth rates for women ages 35 to 54 increased from 2010 to 2017), the only thing standing between you and the unexpected is your contraception.
Because while you may be moaning about your first gray hairs and the fact that it’s suddenly become harder to lose those final (or first) five pounds and you’ve started paying as much attention to your retirement fund as to your kids’ college fund, the reality is that some things really haven’t changed very much. We’re talking about your fertility—your ability to become pregnant. Yes, it’s true that fertility declines with age. However, up to 80 percent of women between 40 and 43 can still get pregnant. In fact, your fertility doesn’t end totally until you reach menopause—the day you’ve gone 12 consecutive months without a period.
Unfortunately, this is a fact that many women your age don’t know. One study found that women in their late 30s and early 40s who were still sexually active thought that if they didn’t get pregnant, they were infertile. Nope. They were just lucky.
In another study of 55 women with a median age of 72, just 55 percent said their health care professional ever discussed sex with them once they turned 40. You can bet that if their health care professionals weren’t talking to these women about sex, they probably weren’t talking to them about contraception either.
Bottom line: If you don’t want a child, you and/or your partner should take precautions to prevent pregnancy.
What to Use
By this point in your life, you’ve probably been through the contraceptive version of soup to nuts. Birth control pills, IUDs, condoms, jellies, and creams.
So now what do you do?
That depends on your answer here: Do you want children? Or more children?
If you answered yes, then you need reversible contraception. Your options include:
Birth control pills. Healthy women over 35 can safely use oral contraception, as long as they don’t smoke, have normal blood pressure and have no history of cardiovascular disease. In fact, you can keep using it until age 50.
Rings and patches. Other estrogen-based birth control options include a vaginal ring (NuvaRing), which is inserted into the vagina like a diaphragm with a three-weeks-on-one-week-off schedule, and a skin patch embedded with hormones, such as Ortho Evra.
Progestogen options. These options include injections (Depo-Provera) and horomone-releasing intrauterine devices (IUDs), such as Mirena, Skyla and Liletta. All use the hormone progestogen for long-term prevention of pregnancy. Injections must be given every three months; the IUDs can last three to six years.
Nonhormonal options. Copper IUDs, spermicides, the Today Sponge, diaphragms, cervical caps and condoms provide protection without hormones, but none are as effective as hormonal measures. Barely any women 35 and older use barrier methods.
Now, if you answered “no” to the question above, then you might want to consider permanent contraception, either for you or your partner. Female sterilization is the most common form of contraception overall, and the birth control method used most often by women 35 and older. A tubal ligation, often called “getting your tubes tied,” is a surgical procedure. A surgeon makes a small incision through the abdomen, inserts a laparoscope to view the pelvic region and tubes, and either blocks the tubes with a ring or burns or clips them shut. It is performed as a laparoscopy, laparotomy or mini-laparotomy. Depending on the type of surgery, recovery is usually one to three weeks.
Of course, you can always insist that it’s time he took care of the birth control option and had a vasectomy.
No matter what you choose, just choose. Otherwise, you may find your 40s more, um, interesting than you’d planned!
Young man opening a condom
The operation usually involves cutting or blocking the fallopian tubes, which carry eggs from the ovaries to the womb (uterus). This prevents the eggs from reaching the sperm and being fertilised. It’s a fairly minor operation and many women can return home the same day.
The vaginal ring is a small, soft plastic ring that’s placed inside the vagina on the first day of a woman’s period. It is removed after 21 days. A new ring is used 7 days later. A vaginal ring is about 4mm thick and 5.5cm in diameter. It contains oestrogen and progestogen, so it’s not suitable for women who can’t take oestrogen-containing contraception.
Natural family planning (fertility awareness-based methods)
Natural family planning (also known as fertility awareness-based methods) is when natural signs, such as cervical fluid or body temperature, are used to identify when a woman is at her least and most fertile during each menstrual cycle. This can be used to help either avoid or plan a pregnancy.
Natural family planning is estimated to be around 75 to 99.6% effective — so it’s possible that you will still become pregnant if you use this approach. There are several fertility awareness-based methods of birth control and while some are highly effective, others are less so. Apps that track and predict a woman’s menstrual cycle are not generally accurate enough for birth control purposes.
When can I use contraception again after having a baby?
It’s possible to become pregnant again very soon after the birth of a baby, even if you’re breastfeeding and even if your periods haven’t returned. You ovulate (release an egg) about 2 weeks before your period arrives, so your fertility may have returned before you realise it.
It’s important to sort out contraception from the start. If you had your baby in hospital, you should discuss contraception with your doctor or midwife before going home. You’ll also be asked about contraception at your 6-week postnatal check, but you can discuss it at any time with your midwife, doctor or local family planning / sexual health clinic.
You can use male and female condoms as soon as you feel ready to have sex. The combined pill, progestogen-only pill and contraceptive implants can be used from 21 days after the birth. However, the combined pill is not recommended if you are breastfeeding because it can affect your milk supply.
You can usually have a contraceptive injection or start using a diaphragm or cap around 6 weeks after giving birth. If you used a diaphragm or cap before becoming pregnant, see your doctor or family planning / sexual health clinic after the birth to ensure that it still fits correctly. Childbirth and other factors such as weight loss/gain can have a significant effect. An IUD or IUS can usually be fitted 6-8 weeks after giving birth.
How effective is contraception?
The effectiveness of contraception depends on factors such as:
- your age
- how often you have sex
- whether you use the contraceptive correctly
Most types of contraception are over 99% effective if used correctly. However, the most effective reversible methods are the “fit and forget” long-acting reversible contraceptives (LARCs) – intrauterine devices (IUDs) and contraceptive implants. The male condom is 98% effective if it’s used correctly and consistently. It’s the only type of contraception that protects against STIs as well as pregnancy.
Where can I get contraception?
Places where you can get contraception include:
- your doctor
- a sexual health or family planning clinic
- your pharmacy
If you’re not sure which contraceptive method is right for you, explore your options at .
You may need to change the type of contraception that you use as you get older, after having children, or if your sex life changes in any way.
Fertility usually starts to decline from around age 37, although you will still need to use contraception after this time to prevent unplanned pregnancy. Most women will have reached the menopause by the time they’re 55 years old and can usually be advised to stop using contraception around this time.
Menopause can be a difficult and confusing time for a lot of women. It often comes with several unpleasant symptoms. For example, hot flashes, mood swings and trouble sleeping are a few of the dreaded things you’ve probably heard of.
But when is menopause “over”? When is childbearing really off the table?
“When am I safe to quit using birth control pills?”
As a certified menopause practitioner and midwife at Park Nicollet’s Women’s Center, this is a question I get often.
The answer usually isn’t black and white, as menopause can be very different for every woman. But here are a few important things to consider when it comes to birth control and menopause.
Perimenopause and menopause—what’s the difference?
Perimenopause is menopause’s opening act. It’s the time leading up to menopause when a woman’s hormones begin to change. A women is still having periods during this time, but they become more irregular.
Menopause is the final period a women has. It’s the curtain closing, so to speak. This is known when a woman goes 12 months without a period. Everything after that is post-menopause.
When can I stop using birth control after menopause?
I usually recommend that women use some form of birth control for the first two years after having their last period. But the patch, pill or ring are not suggested as women go into their mid to late 40s. This is due to the high levels of estrogen in these forms of birth control and risk of blood clots.
The safest options for women are condoms or vasectomy. But I also suggest an intrauterine device (IUD), which can also help with bleeding problems during menopause. The mini pill can be used, too. However, if you’re experiencing symptoms of menopause and being treated with the progesterone-only mini pill, it can affect how well it protects from pregnancy.
It’s better to be on the safe side when it comes to protection. Even if you have a few months without a period, you can still get pregnant. And, while it is rare, some women can ovulate and have a random period.
Are there any benefits to taking birth control pills during menopause or perimenopause?
Oral hormonal contraceptives can help regulate periods and reduce bleeding and pain. They also keep your hormones at consistent levels. During perimenopause, this can mean fewer hot flashes. It can also help with acne that can flare up during this time. And, oral contraceptives can help maintain bone health and strength.
I suggest my patients stop taking the pill in menopause. While every woman’s situation is different, there are sometimes risks with staying on the pill. It’s best to consult with your health care provider to help decide what’s best for you.
Are there any risks with taking birth control pills during menopause or perimenopause?
Hormonal contraceptives can sometimes mask symptoms of perimenopause. This can make it difficult to know when you’ve reached perimenopause. And even after menopause, some women can continue to cycle if they stay on hormonal contraceptives.
As women enter their late 40s, I often suggest they stop taking the pill. This is because hormonal contraceptives can increase the risk of blood clots—especially as you age. I suggest patients try hormone therapy instead. The lower dose of estrogen decreases risks, but still provides similar benefits as the pill.
When should I start talking to my health care provider about all of this?
Some women choose not to see their provider when they begin experiencing symptoms. Instead, these women wait until their annual physical exam and address it then.
If you experience symptoms that are concerning, like heavy, irregular periods, make sure to consult your primary care provider. Same thing goes if you feel the symptoms are affecting your quality of life. Menopause is a common, and important, phase of life. And your health care provider can help determine what the best options are for you.
For more information or to schedule an appointment today:
- HealthPartners OB-GYN
- Park Nicollet OB-GYN
- HealthPartners Central Minnesota Clinics
- Hudson Hospital & Clinic
- Amery Hospital & Clinic
- Lakeview Hospital
Q: I am 47 years old and take oral contraceptives. My gynecologist says I can take them until age 50, but then I should stop so I can see where I am with menopause. I do not smoke and am in good health. Is it safe to keep taking oral contraceptives?
Good for you for taking steps to prevent an unwanted pregnancy! I see too many women your age who think they’re “too old” to get pregnant and just give up on birth control. But until you have gone 12 consecutive months without a period (the true definition of menopause), you could still become pregnant.
There’s no age limit on any contraceptive option. Having said that, however, it’s clear that some options are more appropriate than others based on a woman’s individual circumstances and health profile.
For instance, you don’t mention if you’re married, in a monogamous relationship or dating, or how sexually active you are. All are issues you should discuss with your health care professional when determining contraceptive options. For instance, if you’re having sex infrequently, you might want to consider a barrier method, such as a condom or diaphragm.
The most common birth control method used by perimenopausal women is sterilization, either tubal ligation, i.e., “having your tubes tied,” or hysterectomy. Either is a pretty drastic option, however, since both involve surgery. Plus, research shows that other options can be just as effective when used appropriately.
If you’re experiencing the heavy menstrual bleeding common to perimenopausal women, talk to your health care provider about the levonorgestrel IUD, which not only provides effective birth control, but may also help with the heavy bleeding. And, of course, another good option is the one you’re already using—oral contraceptives. The combination estrogen-progesterone pill Natazia is the first birth control pill specifically approved by the FDA to treat heavy menstrual bleeding not caused by a condition of the uterus.
Decades ago — in the 1970s—women over 35 were told to stop taking oral contraceptives because of the potential risk of heart disease. Since then, however, we’ve learned that risk exists primarily for women who smoke, making birth control pills a good option for nonsmoking premenopausal women of any age. Plus, given the drop in the amount of estrogen used in oral contraceptives in recent years, the risks of other health conditions, including blood clots, stroke and heart disease, have also dropped.
In fact, long-term use of birth control pills has numerous health benefits, including reducing the risk of ovarian cancer, probably by preventing ovulation. Studies also suggest that birth control pills reduce the risk of endometrial cancer, colorectal cancer, pelvic inflammatory disease, fibroids and even endometriosis, as well as helping alleviate some of the heavy bleeding related to fibroids and endometriosis.
One of the main reasons perimenopausal women choose oral contraceptives as their contraception of choice is to help reduce the heavy bleeding and irregular periods often a part of this time of life. There’s also some evidence they can help maintain bone density and reduce the risk of osteoporosis, as well as reduce the incidence of hot flashes, both of which concern perimenopausal women. An added bonus—they can help clear up middle-aged acne.
So, to summarize, it’s fine to continue taking birth control pills up to age 50 or even 51 (keep in mind that the average age of menopause in this country is 51) as long as you don’t have any risk factors for heart disease or other potential complications, including smoking, obesity, diabetes, high cholesterol, high blood sugar or migraines.
One reason your doctor suggested you stop taking birth control pills when you turn 50 is so you’ll know if you’ve reached menopause. If you continue taking them as directed—with a week’s break between active pills—you’ll continue to menstruate and won’t know.
Although the decision is between you and your doctor, you may want to consider at least taking a break for a few months and using a non-hormonal contraception to see if your periods continue, or if you have reached menopause and no longer need contraception.
Women over 40 can use a variety of hormonal and nonhormonal contraceptive options, including the birth control pill, patch, ring, shot, IUDs, condoms, and diaphragms. Some factors might influence birth control choices for women this age, including perimenopausal symptoms, lower fertility rates, desire for children (or lack thereof), and other health concerns.
Perimenopause and Birth Control
Hormonal contraceptive options that contain estrogen might help alleviate symptoms of perimenopause in women over 40. Some doctors recommend birth control pills for perimenopausal women to make their periods lighter and more regular. The estrogen in birth control pills might also help relieve hot flashes.
Efficacy Levels in Birth Control
Women have significantly lower fertility levels in their 40s. Because they have much lower chances of becoming pregnant, some women this age are more comfortable using birth control options with slightly lower efficacy levels, such as condoms, the withdrawal method, or natural family planning.
It’s good to note, women over 40 can still become pregnant using these methods. Therefore, they should still consider contraceptive options with higher efficacy rates, such as the pill, patch, ring, shot, or IUD.
Permanent vs. Temporary Birth Control
Birth control can help ensure women over 40 don’t experience unplanned pregnancies. Women who wish to remain child-free or don’t want more children might consider female sterilization as a permanent birth control measure. With menopause approaching, however, these women should weigh the pros and cons of continuing birth control use versus having an invasive procedure performed.
Other Health Concerns
Some health issues women in their 40s experience might affect which birth control they choose. For example, the birth control shot can affect bone density, so it might not be a good fit for a woman with osteoporosis. The risk of deep venous thrombosis, pulmonary embolism, blood clots, stroke, and heart attack increases with age, so women over 35 might be advised to take progestin-only pills rather than pills containing estrogen (which is also linked to an increased risk of cardiovascular issues).