Contraception & menopause
Can pregnancy occur after menopause? And which contraceptives can be used alongside HRT? Dr Sarah Glynne, a GP with a special interest in menopause, sets the record straight.
Menopause is diagnosed when a woman has had no periods for 12 months. The average age of menopause is 51, but women often notice a change in their health and periods from their mid to late 40s – the perimenopause. It’s worth noting that one in 100 women will have a premature menopause, under the age of 40 (premature ovarian insufficiency or ‘POI’), however. Spontaneous pregnancies have been reported in women up to the age of 59 years, and it is therefore important that all perimenopausal women use contraception if they wish to avoid becoming pregnant. Additionally, women having sex with new partners will continue to need barrier contraception after menopause to protect them from STDs.
How do I know if I need contraception?
If women are under 50 years old and not having periods, they can stop using contraception two years after their last period. If women are over 50, they can stop using contraception one year after their last period. If women are still having periods, or if they are using hormonal contraception (the combined pill, the progesterone-only pill, the progesterone injection or implant, or the progesterone-containing coil – Mirena), or hormone replacement therapy (HRT), they should continue to use contraception until the age of 55.
Women may wish to stop using contraception earlier. It can be difficult to know if women using hormone contraception are menopausal, as they are not having natural periods. In this case, ask your GP for a blood test (follicle stimulating hormone ‘FSH’). If the FSH is in the menopausal range, contraception only needs to be continued for one more year. If it is still in the premenopausal range, contraception should be continued and the blood test can be repeated after one year.
Note, FSH levels are unreliable in women using the combined pill or progesterone injections. These medications need to be stopped six weeks before a blood test, in which case alternative contraception should be used.
What are my options?
The combined pill contains synthetic estrogen and progesterone. It is useful to treat menopausal symptoms and provide contraception up to age 50. It also reduces the risk of osteoporosis. It is particularly suitable for women with POI, who may prefer not to take HRT until they are older.
Historically, women were advised to take the combined pill for three weeks out of four. We now know it isn’t necessary to have a bleed every month, so it is better to t
