Contraceptive Options For Women Approaching The Menopause

Age is the Number One cause of infertility, as any woman who is trying to conceive in her late thirties or early forties knows. While plenty of women in their forties, and some in their fifties and sixties, now get pregnant and have healthy babies with the help of fertility treatment, getting pregnant naturally is another story entirely.

Did you know that women between the ages of 45 and 49 have a two to three percent chance of conceiving spontaneously, while that chance drops to less than one percent once a woman reaches 50?

These figures are frustrating if you are hoping to get pregnant naturally. If you are done having kids, they may seem like a great reason to ditch birth control altogether — the odds of getting pregnant are really quite small, after all!

But think twice. If you are over 40 and want to avoid pregnancy, you should remember that those few-percent odds are quite a bit larger than zero.

What are the most suitable birth control options for women who are approaching the menopause, then? Leaning towards more permanent contraceptive options such as tubal ligation, tubal ligation implants, contraceptive pills or plain old condoms?  

Perimenopause Symptoms

— and for the average woman, this happens at age 51. When a woman enters the menopause, her ovaries stop producing mature follicles, her menstruation comes to a halt, and her hormonal cocktail changes. The menopause is a step-by-step process that actually takes years, and the transitional period is what we call the perimenopause. 

The average length of the perimenopause is four years, but it can take as little as a few months or as much as a decade, too. 

So, how do you know when you are transitioning? Not menstruating as frequently as before is one important tell-tale sign that you are perimenopausal. Hot flashes, tender breasts, vaginal dryness, general fatigue, and mood swings are other signs you should watch out for. 

Can you quit using birth control once you are sure you are perimenopausal, then? No! Not unless you are totally OK with the idea of adding a baby to your family. While it is unlikely that you will get pregnant, a significant minority of women does indeed conceive spontaneously during the perimenopause. Women who wish to avoid pregnancy can quit using contraceptives only once their periods have been absent for a full 12 months. Or in other words, until they have reached the menopause. 

Contraceptive Options For Older Women

Natural Family Planning

First, let's take a look at contraceptive options that women who have perimenopause symptoms or are beyond their mid-forties should not be using. These are the natural birth control techniques that many women use successfully for decades, but that become entirely unreliable when you are transitioning toward the menopause. 

Because your periods and ovulation are becoming less frequent, it is simply hard to predict when you ovulate — and therefore also hard to know when you won't be fertile. Cervical mucus also becomes much less reliable when you hit the perimenopause. You may think that your mucus is "non-fertile" and then get pregnant, as indeed happened to someone I know. 

Intrauterine Devices And Tubal Ligation

Intrauterine devices, or IUDs, are much-overlooked contraceptives in the United States. Two forms are on the market in the US: the Paragard IUD and the Mirena intrauterine system. Paragard is a copper IUD that prevents pregnancy for 10 years, while Mirena is a plastic device that also has a hormonal reservoir. The Mirena can be used for five years. 

Intrauterine devices are specifically designed for long-term use, and obviously need to be removed when you stop using them.

A less invasive form of "tubal ligation" has now been on the market for some time. Essure and Adiana implants are inserted into the fallopian tubes, where they create a blockage that ensures sperm and egg cannot meet. These methods do not impact hormone levels or menstruation, and the same goes for the more traditional tubal ligation surgery. While these methods are great for older women because they are permanent, they might be too costly to invest in if the menopause is already on the horizon. 

Hormonal Contraceptives

Combined oral contraceptives and other combined hormonal contraceptives such as the birth control patch and NuvaRing have pros and cons during the later stages of a woman's reproductive years. Women who are over 35 and smoke less than 15 cigarettes a day should not use combined hormonal contraceptives unless they have no other acceptable option, according to the World Health Organization's Medical Eligibility Criteria (MEC) that govern contraceptive use.

If a woman over 35 smokes more than 15 cigarettes a day, she falls into category four of the MEC — which means she should absolutely not use combined hormonal contraceptives. The risk of myocardial infarction and stroke simply become too high at this point. 

There are some pros as well as some cons. The birth control pill essentially acts as a form of Hormone Replacement Therapy, but with a larger dose of hormones. The birth control pill will prevent pregnancy while also reducing the perimenopause symptoms most women struggle with — vaginal dryness, hot flashes, and mood swings. 

Now for the con — combined oral contraceptives will give a woman the appearance of regular cycles even when she might already have stopped had she not been using them. Older women who are on the pill can stop using it for a month and have their levels of Follicle-Stimulating Hormone (FSH) checked to see if they have reached the menopause. If you want to have a clear picture of what is going on with your menstrual cycles during the perimenopause, combined hormonal contraceptives are not for you.

Condoms

Condoms are a favorite form of contraception among perimenopausal women because they don't artificially alter hormone levels. Providing they are used correctly, they have a 98 percent success rate.

If you decide to go with condoms, you may want to keep emergency contraceptives at home in case one breaks or slips off. Since perimenopausal women typically experience vaginal dryness, you may also want to add a good lubricant that does not damage latex to your bedroom cupboard.