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What are the best methods of contraception for women over 40, and when can women stop using contraception?

Pregnancy can still occur in women over 40, even if they are experiencing irregular cycles and symptoms of the perimenopause, so choosing a highly effective contraceptive method is important. Options include:

  • Long-acting reversible contraception (LARC), such as intrauterine devices (coil) and contraceptive implants, can be particularly suitable options due to their high efficacy rates and long durations of use.

  • Some women over 40 can still safely use combined contraceptive pills, and these not only prevent pregnancy but can also offer additional benefits such as regulation of menstrual cycles, reduction of pain and bleeding, and improvement of perimenopausal symptoms such as hot flushes.

  • Progestogen only 'mini' pills can be safely used up to the age of 55, and sometimes used alongside HRT if needed.

  • Barrier methods such as condoms can provide effective contraception and protection against sexually transmitted infections (STIs). While these methods may not offer the same level of efficacy as hormonal or LARC methods, they can still be suitable options for women over 40, particularly those in monogamous relationships or who are not candidates for hormonal contraception.

Special consideration should be given to women who need contraception and are struggling with the perimenopause, often with irregular and heavy periods, as some methods are also effective at managing bleeding, and can be used as part of an HRT regimen if needed. It is always best to discuss your individual situation and requirements with a doctor who is experienced in providing both contraception and menopause care, to find the most suitable method for you.

When can you stop using contraception?

Although fertility naturally declines with age, it is still important to use contraception until one year following the last natural period. Some women may not be able to tell whether or when they have had their last natural period if they are using a method of contraception that affects the cycle. Once a woman reaches the age of 55, it is assumed that they are no longer at risk of pregnancy. In some situations, a blood test may help to decide when contraception can safely be stopped in a woman who is not having natural cycles.

Dr Helen Kennedy, Women’s Health Doctor and Menopause Specialist at The Maxwell Practice

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