As women age they have an increased risk of certain health conditions which, combined with the symptoms and treatments for any perimenopausal symptoms, means they may have a distinctly different set of needs from younger women. Choosing and stopping appropriate contraception requires an understanding of the health benefits and risks of each method, and the non-contraceptive advantages and disadvantages for this age group
When is contraception no longer needed in menopause?
Menopause is usually a clinical diagnosis made following 1 year of
No periods. Most women do not require measurement of their serum hormone
levels to make the diagnosis. Contraception can be stopped at this stage.
If needed, women over 50 using progestogen-only contraception e.g the mini pill or injection can have serum follicle stimulating hormone (FSH) measurements undertaken to check menopausal status. These methods commonly can stop periods which may cause some confusion as to whether the woman is now in a post menopausal stage
Women using Combined oral contraceptive pills or HRT have suppressed levels of estradiol and gonadotrophins; Therefore hormonal testing would lead to inaccurate results on which to base diagnosis of ovulation and fertility.
In general, all women can cease contraception at age 55 as spontaneous
conception after this age is exceptionally rare even in women still experiencing
menstrual bleeding. If a woman aged 55 or over does not wish to stop a particular method,
consideration can be given to continuation providing the benefits and risks for
her as an individual have been assessed and discussed with her.
Can hormone replacement therapy be used alongside or in place of contraception?
Women using sequential HRT should be advised not to rely on this for
contraception.
Women may use a Mirena IUS alongside oestrogen for up to
5 years for endometrial protection as part of an HRT regimen. Women
using Mirena for this purpose must have the device changed every 5 years.
At the present time, the mini pill, implant and injection are not licensed for and cannot be
recommended as endometrial protection with oestrogen-only HRT.
All progestogen-only methods of contraception are safe to use as contraception
alongside sequential HRT.
The combined pill can be used in eligible women under 50 as an alternative to HRT for relief of menopausal symptoms and prevention of loss of BMD. Women who are already using the combined pill may wish to continue as symptoms may be managed well.
If you would like expert advice and guidance on how best to manage your contraception during Menopause please get in touch to arrange a consultation tailored to your needs
Amanda
