Contraception During Perimenopause and Menopause: Risks and Benefits

Most people are familiar with menopause. Often referred to as "the change", menopause represents a stage in life where dramatic changes occur in a woman's body. One such change involves the ability to conceive children naturally. What many may not realize, however, is that menopause is more than a single timeframe.

Key takeaways:
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    Menopause begins when a woman has gone for 12 months without having a period.
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    Some statistics suggest a pregnancy rate of 10% in women ages 40-44 and less than 5% in women ages 45-49.
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    The risks associated with contraception use during perimenopause are particularly elevated in women who smoke or who have a history of diabetes, blood clots, heart disease, or high blood pressure.
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    Hormonal contraception is not a substitute for hormone replacement therapy (HRT).

There are multiple stages of menopause, each with different effects on female hormones and fertility. There are often questions about using contraception during perimenopause and menopause.

What to know about perimenopause and menopause

To understand the risks, pros, and cons of taking contraception during the various stages of menopause, it helps to understand the basic characteristics of perimenopause and menopause.

Perimenopause

Occurs in the months and years before the onset of menopause. Sometimes called the menopausal transition, this period is characterized by the beginnings of hormonal and menstrual changes that signal the eventual arrival of menopause. During perimenopause, the ovaries produce fewer hormones, leading to irregular menstrual cycles. Because ovulation and menstruation continue during perimenopause, it is still possible to conceive naturally. For some women, perimenopause begins in their mid-30s, and for others, in their mid-50s. As perimenopause progresses, monthly cycles become more and more unpredictable before monthly periods eventually stop.

Menopause

Begins when a woman has gone for 12 months without having a period. In most cases, the transition to menopause (perimenopause) can last between seven and fourteen years, usually ending in a person's late fifties. Menopause can also be triggered by surgical procedures that involve the removal of the ovaries. Once a woman enters menopause, she no longer ovulates and there is little risk of natural pregnancy.

Why use contraception during perimenopause?

Perimenopause can last for several years. During the early stages, while the monthly cycle is still present, there is still a chance of conception. As a result, there are benefits to using contraception throughout perimenopause.

Pregnancy prevention

The first, and perhaps most common, a reason to use contraception during perimenopause is to prevent pregnancy. Remember that perimenopause can begin as early as a woman's thirties. In most cases, the onset of perimenopausal symptoms starts in one's mid-forties. However, this does not mean that a woman is no longer fertile. Many women throughout their thirties and forties conceive naturally each year, although pregnancy rates are lower. Regardless of reduced potential, a perimenopausal woman who does not want to conceive should consider discussing contraception options with her care provider.

Hormonal regulation

Another benefit of contraceptives during perimenopause is hormonal regulation. Perimenopause signals the start of hormonal changes that will eventually lead to menopause. The ovaries begin to produce less estrogen and other hormones that regulate your menstrual cycle. Additionally, symptoms such as hormone-related headaches, menstrual migraines, mood swings, bone health, and other common symptoms associated with monthly periods can benefit from hormone regulation through oral contraceptives.

Additional benefits of contraception during perimenopause

  • Regulate menstrual cycles.
  • Reduce menstrual bleeding.
  • Decrease the risk of ovarian and uterine cancers.
  • Help with painful periods.
  • Reduce the intensity of hot flashes.

Are there risks to using contraception during perimenopause?

Multiple types of contraception exist, but not all are ideal for everyone. It is important to discuss your treatment needs with your provider, especially if you are considering changing your contraception or trying a new medication for the first time. It is also crucial to note that in addition to the benefits of using contraception listed above, there are some potential risks you should discuss with your provider.

For example, the use of certain oral contraceptives in women during perimenopause has been associated with the following:

  • Increase in strokes.
  • Increase in heart attacks.
  • Higher breast cancer risk.
  • Increased risk of blood clots.

The risks associated with contraception use during perimenopause are particularly elevated in women who smoke or who have a history of diabetes, blood clots, heart disease, or high blood pressure.

Is contraception necessary during menopause?

Every woman is different, and there is no single age at which every woman is no longer at risk for pregnancy. The North American Menopause Society and the American College of Obstetricians and Gynecologists suggest women continue using contraceptives until they enter menopause. Once a woman has entered menopause, it is not necessary to use contraception to prevent pregnancy.

The ongoing use of certain hormonal birth controls may mask some of the symptoms of menopause, making it challenging to know menopause has started. For example, hormonal birth control may limit night sweats and hot flashes. Hormonal contraception may also cause continued bleeding similar to a regular menstrual cycle.

Many providers recommend stopping combination birth control pills when you reach the age of fifty due to other health-related risks that could make using combination pills dangerous for this age group. If pregnancy prevention is still necessary, there are progestogen-only pills or other options for women who are unsure if they have entered menopause.

Final thoughts

In general, once a woman has reached age fifty-five, birth control to prevent pregnancy is no longer necessary. It is also crucial to note that hormonal contraception is not a substitute for hormone replacement therapy (HRT). The estrogen levels found in oral contraceptives are often far higher than those in hormone replacement therapy medications. Ask your provider for more information about HRT and personalized remedies to help you manage your menopause symptoms without continued high-dose estrogen.

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