During perimenopause, your menstrual cycles become more irregular as your reproductive hormones start winding down. You’ve officially reached menopause when you haven’t had your period for 12 consecutive months. For most people, this process typically begins in their 40s and 50s, but it can start even earlier.
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But even with irregular periods, you can still get pregnant.
“You still need birth control if you want to prevent pregnancy because your ovaries can still ovulate,” says Ob/Gyn George Drake, DO. “You may have a menstrual cycle once every two, three or even six months, and then go back to menstruating every month again for a while.”
Dr. Drake explains the best birth control options for perimenopause and how they may impact menopause.
There are two main types of birth control: Hormonal birth control, which uses hormones to prevent pregnancy, and nonhormonal birth control, or barrier methods, which physically stop sperm from fertilizing an egg.
During perimenopause, your personal preferences and medical history continue to be important factors in choosing the right birth control for you.
Hormonal options include:
Nonhormonal barrier methods include:
“Nonreversible sterilization procedures like getting your tubes tied are also an option for people who are 100% done with considering pregnancy,” Dr. Drake says. “This type of sterilization won’t affect menopause or perimenopause.”
Your healthcare provider can help you settle on the best birth control for you in your 40s and 50s. “There’s no one best birth control to use,” he notes. “Those decisions are highly individualized and should be made with your Ob/Gyn or other provider.”
Natural family planning, also known as the rhythm method, involves closely tracking the dates of your menstrual cycles to determine when you’re ovulating each month.
When followed closely, it’s about 75% effective — but only if your periods are regular and trackable. “The rhythm method is not effective during perimenopause because of irregular menstruation, so we do not recommend it,” Dr. Drake states.
“Hormonal birth control suppresses ovarian function, which decreases your risk for ovarian cancer,” Dr. Drake explains. “Regular menstrual cycles can also decrease the risk for overstimulation of the uterus or uterine lining, which lowers your risk for uterine cancer.”
IUDs that contain progestin (a synthetic form of the hormone progesterone) can also provide effortless protection for about five to eight years.
Estrogen-based birth control includes:
For all the positives they can offer, these hormonal methods of birth control also come with potential drawbacks, including an increased risk of:
If you use tobacco products, that risk is even higher, especially if you’re over age 35. So, Dr. Drake urges caution with estrogen-based contraceptives, depending on your age and lifestyle factors.
“I would also consider going off a combined estrogen-progestin birth control pill after 50 for the same reason — those increased risks,” he says. “Your Ob/Gyn can discuss other options with you.”
The answer depends on each person. But Dr. Drake shares a good rule of thumb: “Once you turn 50, and definitely by age 55, stop the hormonal methods, since your chances of pregnancy are lower.
“Instead, continue with other forms of birth control until you haven’t had a menstrual cycle for a full year.”
Barrier methods prevent fertilization by physically blocking or killing sperm. Some people prefer these methods because they don’t affect your hormones, so they won’t mask symptoms of perimenopause.
The risks of using barrier methods are the same, no matter your age. You may experience:
The other risk is pregnancy — the very thing that birth control aims to avoid. “Condoms can break or come off, which is why they fail more often than hormonal methods,” notes Dr. Drake.
Barrier methods stay in their lane. They don’t affect perimenopause, menopause or their symptoms, which means you may start to notice changes like:
But hormonal birth control methods are a different story, Dr. Drake says. “Hormonal birth control can hide a lot of menopause symptoms during perimenopause because it regulates your period. You won’t experience the typical symptoms, which makes it hard to tell whether you can still get pregnant.”
When you’re on hormonal birth control, you’re also less likely to know when you’ve reached menopause. If you’re using hormonal birth control but approaching the standard age of menopause (around 52 years old), talk to a healthcare provider to figure out what’s best for you.
Your healthcare provider may recommend hormone therapy (HT) if menopause symptoms affect your quality of life. But birth control and hormone therapy shouldn’t be a package deal.
“You can go on hormone replacement therapy once you’re menopausal and don’t need contraception,” Dr. Drake explains. “Just remember that hormonal therapy is not and should not be used as a contraceptive, and birth control can have more estrogen or progesterone in it, which can increase your risk of adverse health effects.”
Still not sure of the best route to take? Dr. Drake advises checking in with an Ob/Gyn. These reproductive specialists can help you figure out the best forms of birth control for you at different stages of your life. They can also help with managing perimenopause symptoms and exploring whether hormone therapy is right for you.