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    Contraception and the menopause

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      If you’re a woman going through the menopause and experiencing symptoms like hot flushes and low mood, there’s a good chance contraception is low on your list of priorities. 

      Even though your periods might be few and far between you can still get pregnant; and if you have sex without a condom, you can still catch STIs. That's why it's important to think about contraception and using condoms.

      Can you get pregnant during the menopause?

      Yes, you can get pregnant while going through the menopause. This might happen in the years leading up to your periods stopping, or even after your periods have stopped completely.

      During the menopause your oestrogen levels fall and your ovaries wind down egg production. Your periods are likely to become erratic in the years leading up to the menopause years; they might also become heavier or lighter. This makes conception (getting pregnant) far less likely, but not impossible. 

      In short, if you’re going through the menopause, don’t assume you’re protected from pregnancy, even if your periods are irregular or you’ve missed several in a row. 

      What contraception should menopausal women use? 

      Choosing contraception as you get older may be complicated by a few different factors, including age, weight, lifestyle and medical history. However, these are a few of the options available. 

      Condoms

      A really simple contraception choice for menopausal women is male or female condoms – although male condoms tend to be more effective and more widely available. 

      The benefit of condoms is that they protect you from sexually transmitted infections. This makes them a good option if you’re having sex with new or casual partners, and you aren’t sure of their STI status. 

      The combined pill, patch or ring 

      The combined pill, ring or patch can still be used by many women until the age of 50. If you are 50+, or you have certain medical conditions, you are a smoker or very overweight, combined hormonal contraception would not be safe to take.

      The progestogen-only pill 

      The POP or mini pill is a good alternative pill for women who can’t use the combined pill, including those who smoke. It can be taken up to the age of 55. 

      The implant

      The implant is a small plastic rod that’s fitted under the skin and releases progestogen. It lasts three years and isn’t associated with health complications like blood clots.

      The implant can be used until the age of 55.

      The intrauterine system (IUS)

      The IUS is a small, T-shaped device inserted into the uterus (womb) that releases progestogen. It’s usually changed after 5 years, but depending on your age it can stay in for longer.

      A benefit of the IUS for menopausal women is that it can be used alongside oestrogen-only HRT. Women who still have a womb need to combine oestrogen with progestogen in their HRT as this protects them from cancer of the womb. 

      The IUS can be used up to the age of 55.  

      The intrauterine device (IUD) 

      The IUD is like the IUS but it doesn't contain any hormones. It releases small amounts of copper instead. The drawback is that it can make your periods heavier or more painful. 

      Depending on the amount of copper an IUD releases, it can stay inside the womb for 5 or 10 years. If you've had a 10-year coil inserted in your 40s it can stay in until 1 or 2 years after your last period, even if this is in your early 50s.

      The injection 

      The progestogen-only injection is given every eight to 13 weeks. It’s safe for menopausal women, however when used on a long-term basis it’s associated with a loss of bone density (osteoporosis). Because your bones thin naturally after the menopause, your GP may recommend an alternative type of contraception.

      Sterilisation 

      The main benefit of sterilisation is that once you’ve had it done, you don’t have to think about contraception again. However, it does involve a small operation, and there’s usually a recovery period during which you might have some pain and discomfort. 

      If you’re a woman in a long-term heterosexual relationship, another option is for your male partner to have a vasectomy.  

      Stopping contraception after the menopause

      When you stop using contraception depends on a few factors:

      • Whether you’re over 50 
      • Whether your periods have stopped 
      • Whether or not you’re using hormonal contraception

      Generally, if you’re over 50 you’ll need to keep using contraception for a year after your last period. If you’re under 50 you’ll need to use it for two years after your last period. 

      For women using hormonal contraception, the guidance will be different. This is because hormonal contraception can cause withdrawal bleeds, as well as irregular or missed periods. All of these things can make it hard to work out whether you’re still ovulating and still able to get pregnant. 

      If you’re using any kind of hormonal contraception and you start having menopausal symptoms, the best thing to do is talk to your GP. Or you could book an appointment with one of doctors, using VideoGP, to talk to them about the menopause. 

      Find out more about speaking to a GP about the menopause here

      VideoGP by LloydsPharmacy

      References

      https://patient.info/sexual-health/contraception-methods/contraception-for-the-mature-woman
      https://www.nhs.uk/conditions/contraception/contraceptive-implant/
      https://www.nhs.uk/conditions/contraception/contraceptive-injection/
      https://www.nhs.uk/conditions/contraception/female-sterilisation/
      https://patient.info/womens-health/menopause  

      Authors and editors

      • Reviewed and updated by

        Dr Tatjana Street
        GMC number: 4569536
        Date reviewed: 19th November 2021

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