Do you still need to use contraception during the menopause?

Although the chances of pregnancy during menopause and peri-menopause are decreasing it is still possible so it is very important that contraception is used at this time as your body can still ovulate even if your periods are irregular.

It is advised that women need to continue to use protection for 12 months after their last period if aged over 50 or 24 months if aged under 50.

Although, if you are taking the combined contraceptive pill it can often be difficult to decipher if your natural cycle is changing as the menstrual cycle is brought on due to hormones in the pill. If you are taking a progesterone only contraception such as the implant, injection, POP or coil containing hormones you may not even have any form of periods, which can make it much more difficult to know when menopause occurs.

If you have lost track of when your last period was or you are using a method of contraception where you do not know what stage you are at you can request a blood test with your GP to check your level of Follicle Stimulating Hormone (FSH). If this comes back as a high level you would still need to continue using your chosen method of contraception for the advised time of 2 years, if you are under 50 years of age or 1 year if over 50. If you are taking the combined contraceptive pill and need a blood test you should stop taking this for 6 weeks before the test is taken to be sure of an accurate result but you must ensure that adequate contraceptive protection is used during this waiting time. However, if you have a POP or a Mirena coil fitted there is no need to remove these before any FSH test.

There are various options of contraception available for women during menopause:

• Barrier methods – Condoms, diaphragms and cervical caps can all be used to prevent pregnancy by physically blocking the sperm from reaching the egg
• Hormonal protection – Hormonal contraceptives such as the combined oral contraceptive pill. This can be a popular choice in younger women but usually needs careful consideration in women over the age of 40. It should be avoided over the age of 35 years if you smoke or are overweight. In women who are fit and healthy, such as those without cardiovascular risk factors or migraines, taking the pill can have considerable benefits in regulating periods and reducing the heaviness of flow. It can also be used in place of hormone replacement therapy to treat menopausal symptoms and prevent osteoporosis in women under the age of 50 years.
• The implant – This is a method where a small plastic rod is inserted just underneath the skin at the top of your arm. This contraception method can last for 3 years before needing replacing and could help with heavy, painful periods but can also cause your periods to be irregular.
• Progesterone only pill – This has fewer risks associated with it and can be taken safely at any age, for as long as contraception is required. On the progestogen-­only pill, periods can become irregular, stop altogether or last for longer.
• Coils – there are several forms of coils available. Copper coils are are highly effective and can provide long term contraception wand can be left in place until after the menopause. The Mirena coil contains the hormone progesterone and has three main uses: as a contraceptive; a treatment for heavy periods – about half of women stop having periods with it – and it provides the progestogen component of HRT. If being used for the latter, it needs changing after five years.

In general, all women can stop using contraception at the age of 55 as natural conception after this age is exceptionally rare, even in women still having some periods.