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It is easy to think when a woman reaches a certain time in her life, she can finally stop her contraception. Finally, there is no need to worry about forgetting to take a pill every day or the date she must go for a repeat injection, etc. However, whilst the chances of becoming pregnant in perimenopause and menopause is low, it does not stop completely straight away.
What are the risks?
The risk of pregnancy in women aged 40-44 years is around 10-20% and in those 45-49 years is around 12%. After 50 years the chances drop to less than 5%. So even though the chance of pregnancy is low it is important to continue contraception into the Menopause if a pregnancy is not wanted.
The risks to the health and well-being of both mother and unborn foetus are higher in women over the age of 40 years. This group of women are at the highest risk of miscarriage or stillbirth compared to live births and often women are more likely to opt for termination which leads to additional anxiety and stress.
How long do I continue taking contraception after menopause?
The British Menopause Society recommends women continue taking contraception for 2 years after their final period if that occurred before age 50 years or continue for 1 year after their final period if that occurred after age 50 years.
Provided there are no contra-indications such as smoking or raised body mass index, most hormonal contraceptives are safe for healthy women up to the age of 50 years. If a woman has a copper intrauterine device, (IUD) fitted around age 40 years it can stay in place until after menopause has been confirmed. The Progesterone-only Intra-Uterine System, (IUS) can be used for 5 years alongside Oestrogen-based HRT as a contraception and is also licenced for use as the Progesterone arm for endometrial protection but must be changed after 5 years.
Things to remember after stopping contraception
Maintaining good sexual health is essential even after contraception is discontinued it is important to remember the risk of the transmission of sexual infections does not diminish. Therefore, safer sex should be maintained especially with new partners. Condoms are the only form of contraception that will protect against most sexual infections, including HIV, if used correctly. Vaginal lubricants and moisturisers can be used with condoms but if using latex ones ensure the moisturisers and lubricants are water-based as oil-based products will warp the latex and cause them to split.
Just because a woman reaches perimenopause or menopause does not mean she can no longer get pregnant. It is essential to ensure, if she doesn't want a baby later in life, she should continue contraception use. Along with condom usage women can enjoy a healthy sex life for as long as they want to.
References
Panay, N., Briggs, P. & Kovacs, G.,(2020) Managing the Menopause, 2nd Ed.
Understanding your Odds of Pregnancy, (2023) www.miracare.com
Hillard, T, et al, (2021) Management of the Menopause, 6th Ed.
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