Contraception can be confusing around menopause, and finding clear advice can be difficult. The simple message is that contraception is required if you are pre- or peri-menopausal and you don't wish to become pregnant. The chances are low, but cases of pregnancy have been known to occur.
Any contraception should be continued for at least two years after menopause (your last period) if you are under 50, or for at least one year if you are older than 50. If you’re not entirely sure when your last period was, current guidelines recommend stopping contraception at the age of 55, as pregnancy is especially rare after this time.
There are a variety of contraception options available during perimenopause and choosing which to take comes down to personal choice. There are long-acting contraceptives, tablets and barrier methods. Each has its advantages and disadvantages, which we will cover below.
The combined pill is the most common type of contraceptive, and many women are happy to continue taking it. However, guidelines advise that anyone over 50 should review their contraception and avoid taking the combined pill for safety reasons. If you wish to continue with an oral tablet, changing to a progesterone-only pill is a good alternative.
Progesterone only pills, such as Cerazette and Cerelle, are very effective and have no recommended age-limit. They have the additional benefit of not affecting your oestrogen levels.
Condoms and diaphragms are less commonly used but can be a useful choice for contraception without relying on hormones. If you are using barrier methods, it should be remembered that vaginal oestrogen creams and oil-based lubricants can damage the rubber, which can lead to accidental rupture of condoms and diaphragms. Using water-based lubricants is the recommended option.
The Mirena coil is an intrauterine device (IUD) and the most popular long-acting contraception method on the market. It is suitable for up to 5 years and works by releasing levonorgestrel, a type of progesterone, locally into the uterus. Levonorgestrel blocks the passage of sperm through your cervix, stopping fertilisation. In addition, it protects the lining of the womb from unwanted overstimulation by oestrogen. This makes the Mirena coil suitable for use as the progesterone component of hormone replacement therapy and is licensed for 4 years for this use.
As the Mirena coil is licensed for both contraception and HRT, it is a useful and straightforward option around menopause. Something to remember is the Mirena coil only contains progesterone. A separate systemic oestrogen patch, gel or pill needs to be taken to replace low oestrogen levels.
Other long-acting contraceptive methods include the copper coil (IUCD), progesterone-only implants and injections. All are very effective contraceptives, but each has some disadvantages which mean other methods are preferable when picking contraception around menopause.
A side-effect of both the copper coil and progesterone-only implant can be heavier or irregular periods, respectively. Both may lead to unnecessary investigations as any heavy or irregular bleeding needs to be reviewed by a doctor and may require further testing. Typically, progesterone-only injections lead to your periods stopping, but these injections have also been associated with a small decrease in bone density, so should be discussed with your doctor.