Amongst the many challenges faced by women who are experiencing perimenopause or menopause, contraception is not one that is frequently talked about. However, with pregnancy theoretically possible up to the age of 55 and hormonal contraception presenting challenges in determining which stage you may be at within menopause, contraception is still a pertinent topic! Menopause and fertility are complex subjects, and there are many questions that surround both, such as – when can you stop using contraception? Can you still get pregnant around menopause? Can hormonal birth control affect your menopause journey? At Health & Her, we’ve spoken to Menopause Specialist, GP Dr Kate Burns, to answer some of most the common queries around contraception in menopause.
How do you know if you’re in menopause when on the pill?
Hormonal contraception can present challenges in determining which stage of menopause you’re in. This is because all methods of hormonal contraception can “mask” or obscure one of the signs of perimenopause; namely, periods getting worse or becoming irregular. For example, when taken the traditional way (i.e. 21 day use of birth control pills, patches, or the vaginal ring, followed by a 7-day break before repeating this cycle), hormonal contraception (CHC) such as the combined pill, will generally give you regular monthly ‘false’ or ‘withdrawal’ bleeds. Other forms of hormonal contraception, such as the progestogen only pill (POP), implants, injections, and hormonal coils, may stop you bleeding altogether. This means that having no or infrequent periods while using hormonal contraceptive does not necessarily mean you are menopausal; just as having regular bleeds does not rule menopause out.
With this in mind, you can use your menstrual cycle to work out whether your periods are becoming irregular or have stopped altogether, but to do this, you would need to stop taking any hormonal contraception. (It is important to note that switching to a non-hormonal contraceptive suddenly would not generally be recommended and we would advise you speak to your GP for further advice). However, this advice does depend on your age, as any type of combined hormonal contraception should only be used until the age of fifty.
When should you stop contraception after menopause?
If you are over fifty, we recommend that you should look at stopping hormonal contraception regardless of whether or not you want to know if you are in menopause, as combined hormonal contraception can increase your risk of stroke or a blood clot in your veins (venous thromboembolism).
It is also possible to have a hormonal blood test in order to work out whether you are in menopause. However, combined hormonal contraception such as the combined pill, combined patch and the vaginal ring will affect your hormone levels and alter the results of a hormonal blood test. To manage this, you could consider switching from a combined hormonal contraceptive to a progestogen-only contraceptive. Progestogen-only contraceptives will not alter the results of a hormonal blood test, but if you choose this option, you should take the progestogen-only contraceptive for at least six weeks before the hormonal blood test to ensure your results are accurate. If you are already on progestogen-only contraception, you can have your FSH levels checked at any time, and this will give you an accurate picture of your menopausal status. The only exception is the depo injection, (depo provera or sayana press), which can actually suppress FSH levels. A FSH level of >30nmol/L can be confidently attributed to a perimenopause, and a result of <30nmol/L cannot exclude it. However, menopause contraception advice does depend on solely on your age. More advice on hormonal blood tests can be found further on in this article.
The truth is, the changes in bleeding patterns that occur during perimenopause, even without the involvement of hormonal contraception, can often lead to confusion too. We would advise you to speak to a GP for advice and questions tailored to you and your experience.
Will the pill make my menopause worse?
In a short answer – no. But there are side effects associated with both the progestogen-only and combined pill, such as headaches, breast tenderness, weight gain, alongside more serious risks such as deep vein thrombosis and blood clots. These risks are more significant with use of the combined pill.
It is important to be aware of these side effects before taking hormonal contraceptives, however, it is also pertinent to note that for women experiencing menopause the pill provides no additional or increased risk, nor is there any evidence to suggest it exacerbates symptoms. In fact, the combined pill can be prescribed as an effective alternative to HRT in helping to manage difficult menopausal symptoms in women under fifty.
Can you still get pregnant around menopause?
The simple answer is, yes. Even though we may think pregnancy is one of the only things we don’t have to think about during menopause, it is possible for women to conceive and carry a child up to the age of 55, so effective contraception is important for the duration of menopause.
When can you safely stop contraception and know you will not get pregnant?
If you have not been using any hormonal contraception or HRT, there is a fairly straightforward answer to this:
Women under 50: If you have your last period under the age of 50 years, pregnancy is still possible for up to 2 years after the date of this last period. So, if you wish to avoid this, you should still use regular contraception until this time is completed. This is because on occasion, periods can restart even after several months of no bleeding and your ovaries may still release eggs.
Women 50 years and over: If you have your last period over the age of 50, pregnancy is still possible for up to 1 year after this last period. So, if you wish to avoid pregnancy, you should still use regular contraception for 1 year from the date of your last period. After this time, you can safely stop any contraception.
ALL Women 55 years or over: Once you reach 55, all women can safely stop contraception. Pregnancy after this age is exceptionally rare, even in women still experiencing some menstrual bleeding – so you can cross this off your list of things to think about! In essence, you can be sure you won’t fall pregnant without contraception after the age of 55, but until then, if you are seeking to avoid conceiving, you should continue to use contraception.
After the age of 55, you can safely stop using contraception and be sure you will not fall pregnant, though if you are engaging in sexual activity with someone new, you should be using appropriate contraception to avoid STDs.
And remember – if you are using either hormonal contraception or HRT, your stage in menopause cannot be measured using your menstrual cycle. As mentioned above, this is because hormonal contraception and HRT affect your natural period cycle, and can suppress periods or prompt ‘withdrawal bleeding’.
Can hormonal blood tests help me work out if I can safely stop contraception?
This depends on your age:
Under 50: No, unfortunately blood tests are no help (regardless of whether or not you are using HRT or hormonal contraception). If you are not using any hormones, you can safely stop contraception when you have reached 2 years after your last period. Otherwise, continue until at least 50 years of age, and then discuss this with your GP.
50 years or above: Yes, potentially! If you are keen to stop contraception before 55, unless you’re using combined hormonal contraception (combined pill/patch/vaginal ring; which actually should not be continued beyond 50), and if you’re not experiencing any vaginal bleeding, checking your FSH hormonal blood levels may help. It is fine to do this if you’re taking progestogen only contraception (implant, injection, POP, hormonal coils). If your FSH is 30IU/L or above, you can stop contraception after 1 more year. If your FSH is <30IU/L then you should continue your contraception and re-check your FSH levels again in 1 year if you wish to.
Will HRT stop me getting pregnant?
No, HRT is never effective as a contraceptive. This is because the types and amounts of hormones used are lower and not enough to prevent pregnancy. The one exception is if you’re using the hormonal coil (or IUS), as part of your HRT regime. This provides effective contraception for at least 5 years. Here is more information about HRT & menopause.
Menopause contraception key facts:
- Menopausal patterns when using hormonal contraception do not reliably indicate what is happening regarding your ovary function and menopause journey.
- Use of HRT does not prevent pregnancy or provide contraception.
- If you are aged under 50 years and not using any hormonal contraception or HRT, you can safely stop contraception 2 years after your last period.
- If you are aged 50 years or above, you can safely stop contraception 1 year after your last period. If you are over fifty, you should look at stopping hormonal contraception in order to avoid the increased risk of stroke or venous thromboembolism.
- If you are aged 50 years or above and using contraception, it may be possible to check your FSH hormone levels via a hormonal blood test in order to figure out when you can possibly safely stop contraception. If your FSH is 30 or above, you can safely stop this after 1 further year. If it is less than 30, you should continue your contraception and consider having your FSH level re-checked on a further 1 year.
- All women over fifty-five years can safely stop contraception (no blood tests needed), as pregnancy is extremely rare at this age.
- GP Notebook