Contraception for women over 40

Contraception for women over 40

Women over 40 have different health profiles to younger women and so may have different contraceptive needs.  As you get older, there are increased risks of some conditions related to your contraceptive choices.

All but two forms of contraception have no age restrictions, however, the age related benefits and risks of each method can change as you grow older.

Also, once over the age of 40, women may need to control symptoms of the perimenopause and take Hormone Replacement Therapy (HRT).  It is really important women know that HRT does not act as a contraceptive.

Perimenopause and menopause

Perimenopause and menopause

Menopause

The menopause refers to the stopping of ovulation and periods. This is normally diagnosed clinically once periods have stopped for 12 months.  Bloods tests are not usually required.

Perimenopause

The perimenopause is a period of fluctuating hormone levels and is the transition period from normal ovarian function to stopping of ovulation and periods.  It starts before menopause and ends 12 months after the last period.

It typically starts mid to late 40s and lasts 4-5 years.  Taking hormonal contraception does not affect when the perimenopause starts or how long it lasts.

The symptoms of the perimenopause include:

  • Hot flushes, night sweats, mood changes, mood swings, anxiety, depression, sleep disturbance, chronic tiredness, joint/muscle pain, changes in severity of pre-existing migraines, loss of libido, vaginal dryness, change in bleeding patterns.

While a change in bleeding is a symptom of the perimenopause, it is important to note that if a women experiences any significant change in bleeding pattern over 40 years of age she should seek advice from her GP.

What contraception can I use?

What contraception can I use?

For women in their 40s no method of contraception needs to be avoided due to age alone.

Once a women reaches 50, combined hormonal contraceptives and the progesterone only injectable contraceptive are not recommended.

The progesterone only pill, progesterone only implant, Mirena IUS, and the copper IUD can all safely be used until the age of 55 – when natural loss of fertility can be assumed.

In addition emergency contraception is not limited by age (and is still required for as long as contraception is required)

Some methods of contraception will also provide non-contraceptive benefits, such as period control.

When should I stop taking contraception?

When should I stop taking contraception?

In general women can stop contraception either:

  • 1 year after their last period if over 50 years old,
  • 2 years after their last period if under 50 years old, or
  • when they reach 55 years of age.

Some women using progesterone only contraception have no periods due to the effect of  their contraceptive.  This can make it difficult to know their menopausal status.  In this situation it is acceptable to simply continue contraception to age 55 years.   For those women who are keen to stop contraception prior to 55, it may be helpful to do a blood test.  If this indicates menopause then you should be advised to continue contraception for another year, if aged over 50, before stopping.

Copper coils can remain in place until menopause, or age 55, if it has been inserted at or after age 40.

Mirena coils can remain in place for contraception until menopause, or age 55, if inserted at or after age 45.

Can contraception be used with or instead of HRT?

Can contraception be used with or instead of HRT?

It is important to understand that contraception should be maintained alongside sequential HRT if perimenopausal, or menopausal status is unknown.

All progesterone only contraceptives are safe to use as contraception alongside sequential HRT

Combined hormonal contraceptives can be used, in eligible women under 50, as an alternative to HRT for relief of menopausal symptoms and to provide bone protection.

Where can I get more advice?

Where can I get more advice?

You can get more advice about the different forms of contraception on our pages. You can also find out more about the symptoms of menopause here.

Your GP will also be able to offer you advice and guidance on everything from ageing well, to contraception or managing the menopause.

You can also book an appointment with us to discuss your contraceptive needs or sexual health.

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Accessing our service during the COVID pandemic

How to access our service:

We have now implemented a telephone triage system for all of our clinics. This system will be in place for the duration of the pandemic. Please contact our services to access this triage system. Our central telephone number is 0300 303 3989.

If you are experiencing symptoms of Coronavirus please do not attend the clinic. Clear advice for people with symptoms of coronavirus is available at nhs.uk/coronavirus .

Advice from our service:

We have updated information on the provision of routine contraception during this pandemic here.

More details on the fitting of LARCs (coils and implants) at our service can be found here

If you need the combined contraceptive pill please try (if you can) to get updated measurements of your height, weight and blood pressure before calling us.

There is also specific advice on coronavirus available for People Living with HIV here, and for pregnant women here

Self-requested Sexual Health screening by post is available for for under 25s only - more info here

For others with testing requirements please contact the service on 0300 303 3989.

Information is now also available to advise on sexual contact during a time of social distancing here.

Alternative provision:

Please be aware that we may have to cancel, rearrange or shut clinical services in response to changing clinical and staffing pressures created by the Coronavirus pandemic. 

If you are struggling to access sexual health services, alternatives may be available:

  • Emergency Contraception - at your local pharmacy - more info
  • Contraceptive pills and LARC procedures - obtained from your GP
  • HIV postal testing - available to at-risk groups for a small fee -  more info
  • HIV PEPSE - available via A+E departments - more info
  • Condoms by post (for gay and bisexual men only) - more info