Contraception around menopause: when can I stop?

In your 40s, your periods often change. They may come closer together, further apart, or skip months. Many women think this means they cannot get pregnant. That is not always true. This guide from Network One Health explains why contraception still matters, and when you can stop.

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You can still get pregnant

The years before menopause are called perimenopause. This stage usually lasts about 3 to 5 years.

During this time, your body still releases an egg some months, but not others. So you can still get pregnant, even if your periods are irregular. You are only free of pregnancy risk once you have reached menopause.

When does menopause happen?

• Menopause usually happens between 45 and 55.
• About half of women reach it by 50.
• By 55, about 96 in 100 women have reached it.

Menopause is confirmed after 12 months in a row with no period, while you are not using any hormones. Hormonal contraception can hide your natural pattern. That is why the rules for stopping depend on your method and your age.

Methods that suit women in their 40s

Age alone does not stop you using any method. What matters is your health. Some conditions become more common in your 40s, such as high blood pressure. Your clinician will check these before you choose.

Copper IUD. No hormones. It is less likely to come out as you get older. If it was put in at 40 or older, it can stay until you no longer need contraception.

Hormone IUD. It often makes periods lighter, and may stop them. This can help if you have heavy periods. If it was put in at 45 or older, it can stay until you no longer need contraception.

Implant, mini pill and injection. These have no oestrogen. They are a good choice for women who cannot use oestrogen. The Depo-Provera injection slightly lowers bone density while you use it. Your clinician can talk this through with you.

Combined pill, patch or ring. These contain oestrogen. They can ease hot flushes and make periods more regular. They are not advised if you are 35 or older and:

• smoke, even a little, or
• get migraines.

Sterilisation or vasectomy. These suit couples who are sure they want no more children. Both are permanent.

Condoms. They protect against HIV and STIs (sexually transmitted infections). Women of any age can get HIV or STIs. If you have a new partner, condoms matter at every age.

Emergency pills. Women of any age can use them.

Note: an IUD can be harder to put in as you get older, because the opening of the womb gets tighter.

When can I stop?

This is the most common question. The answer depends on your age and your method. Here is the advice in the South African national guideline.

If you use a non-hormonal method (copper IUD, condoms):

• Under 50: stop after 2 years with no periods.
• 50 or older: stop after 1 year with no periods.

If you use the combined pill, patch or ring:

• You can continue to age 50.
• At 50, switch to a non-hormonal method or the mini pill, then follow that advice.

If you use the Depo-Provera injection:

• You can continue to age 50.
• At 50, switch to a non-hormonal method and stop after 2 years with no periods. Or switch to the mini pill, implant or hormone IUD.

If you use the implant, mini pill or hormone IUD:

• You can continue to 50 or beyond.
• After 50, if you have no periods, your clinician may do a blood test (called FSH) twice, 6 weeks apart. If both results show menopause levels, you can stop after 1 more year.
• Or you can stop at 55. By then, most women can no longer get pregnant naturally.
• If you still bleed at 55, keep using contraception. Your clinician will also check the reason for the bleeding.

If you want to stop hormones before 50: switch to a non-hormonal method. Stop once you have had no periods for 2 years. If you switched from the injection, wait 3 years, because fertility can take longer to settle.

HRT is not contraception

Hormone replacement therapy (HRT) can ease menopause symptoms such as hot flushes. But HRT does not prevent pregnancy. If you are still in perimenopause and start HRT, you still need contraception.

Some women use a hormone IUD for contraception alongside HRT. Your clinician can explain if this fits you.

Bleeding to check

See your clinician if you have:

• Bleeding after 12 months with no periods
• Bleeding between periods or after sex
• Very heavy bleeding, or a change in your usual pattern

In an emergency, go to your nearest hospital emergency unit or call 10177.

What to expect at Network One Health

Your 40s are a good time for a full check-up. We look at your periods, your health and your plans. Then we help you decide which method suits you now, and when you can safely stop. No question is too small.

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Ready to talk? Ask us to call you or WhatsApp Noma on 065 072 5315 for bookings and questions.