Unless you’re trying to get pregnant, chances are you still need to use some method of birth control in your 40s and 50s. That’s every single time you have sex, up until menopause. This may seem like a no-brainer, but many premenopausal women older than 40 don’t use contraception. That’s why about 75% of pregnancies in women over 40 are unplanned.
You’ll know you’re fully in menopause when you haven’t had a period for 12 months in a row. That means no periods at all, not even occasional bleeding. Irregular periods are common as you approach menopause. So even if you rarely get your period, there’s still a chance you can get pregnant if you don’t use birth control.
For some, a positive pregnancy test comes as a happy surprise. But it isn’t without risks. The odds of pregnancy-related complications increase with age. These complications include gestational diabetes and high blood pressure.
Changing Birth Control Needs
The birth control method you used in your 20s or 30s may not be the best option in your 40s and 50s. Your body has changed. Your life has likely changed, too. Now is the time to review contraceptive options with your doctor.
If you don’t have sex often, you may want to stop daily or long-term birth control and use condoms or diaphragms instead. It’s important to note that these are less effective than the pill or other long-acting methods.
Not all women in their 40s or 50s need to change the birth control they’ve relied on for years. You may be able to stick with your trusted pill, patch, or ring until menopause. Your doctor will consider your weight, tobacco use, blood pressure, and medical history when you talk about your options.
Estrogen-Free Birth Control
If you have certain medical conditions, such as breast cancer or a history of blood clots, your doctor may suggest hormone-free contraceptives. Several types of cancer are sensitive to hormones and grow in their presence. These include certain cancers of the breast, ovary, endometrium, lung, and liver.
Birth control that contains estrogen can also increase the risk of heart problems and blood clots. Smokers older than 35 also shouldn’t take birth control pills with estrogen. For these women, hormone-free or progestin-only birth control may be a good option.
These birth control options, which are either estrogen-free or hormone-free, are reversible if you later decide you want to get pregnant:
- IUDs with levonorgestrel. "IUD" is short for intrauterine device. It’s a T-shaped piece of plastic that your doctor inserts into your uterus. An IUD with the hormone levonorgestrel can make heavy periods lighter and last 3 to 8 years.
- Copper IUDs. These don’t have any hormones. Instead, they rely on a copper wire that’s toxic to sperm and can prevent pregnancy for up to 10 years.
- Contraceptive implant. The doctor inserts a flexible rod, about the size of a matchstick, under the skin of your upper arm. It contains a form of the hormone progestin and can prevent pregnancy for up to 3 years.
- Minipill. This progestin-only pill isn’t associated with a risk of high blood pressure or heart disease. But it’s not as effective as the regular pill or IUDs.
- Birth control shot. You get this progestin-only shot from your doctor every 13 weeks. It might also protect against pelvic inflammatory disease and reduce pelvic pain caused by endometriosis.
Permanent Birth Control
Surgery is an option for men or women. Reversing the procedure may not work, so you should think of it as a permanent method. This makes it a good option if you’re certain you’ll never want children or if you’ve completed your family.
Tubal ligation. You may know this procedure by the more casual term “getting your tubes tied.” The basics:
- It seals both of the fallopian tubes so sperm can’t get through.
- It may reduce the risk of ovarian cancer (especially if your fallopian tubes are removed).
- It can be done any time, including after vaginal delivery or C-section.
Vasectomy. There’s a casual term for this procedure, too. You may have heard it called “getting snipped.” The basics:
- It seals the tubes that carry sperm.
- It's performed in an outpatient setting.
- It's less invasive and less expensive than tubal ligation.
If you have unprotected sex before you’re in menopause, emergency contraception can ensure that your egg won’t be fertilized. Your options include:
- Levonorgestrel (Plan B One-Step, Preventeza, My Way, Take Action). You can get this over-the-counter pill without a prescription. You must take it within 72 hours of unprotected sex.
- Ulipristal (Ella). More effective than Plan B, this prescription-only drug can be taken within 5 days of unprotected sex. It can cause a miscarriage.
- Copper IUD. It must be inserted by a health care professional within 5 days of unprotected sex. Not only is it the most effective of the three options, but about 80% of women keep the IUD inserted as birth control for up to 10 years. It can also cause prevention of implantation of a fertilized egg.
Questions for Your Doctor
To find out about your birth control options, ask your doctor:
- Given my age and phase of life, which types of birth control should I consider?
- Do I need a doctor's prescription for these forms of birth control?
- What are the risks and benefits of birth control hormones found in the pill, patches, or shots?
- What are the risks and benefits of IUDs?
- How do barrier methods of birth control work? How effective are they?
If you’re having problems with your birth control, you may want to ask your doctor:
- Could my problems be related to the type of birth control I use?
- What other birth control methods might work better for me?