Birth Control in Your 40s and 50s

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. This includes gestational diabetes and high blood pressure.

If you don’t want to get pregnant and haven’t yet reached menopause, there are many birth control options that can work with your health and lifestyle.

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 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.

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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 estrogen- or hormone-free birth control options 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 5 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 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.

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Emergency Contraception

If you have unprotected sex before you’re in menopause, emergency contraception can ensure that your egg won’t be fertilized. Your options include:

  • Plan B One-Step. You can get this over-the-counter pill without a prescription. It doesn’t cause miscarriage or otherwise affect an established pregnancy. You must take it within 72 hours of unprotected sex.
  • Ella. More effective than Plan B, this prescription-only drug can be taken within 5 days of unprotected sex.
  • 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.
WebMD Medical Reference Reviewed by Traci C. Johnson, MD on October 31, 2018

Sources

SOURCES:

American College of Obstetricians and Gynecologists: “2011 Women’s Health Stats & Facts,” “Progestin-Only Hormonal Birth Control: Pill and Injection,"  “The Menopause Years.”

Women’s Health Research Institute: “Pregnancy Possible During Perimenopause.”

Geburtshilfe und Frauenheilkunde: “Pregnancy and Obstetrical Outcomes in Women Over 40 Years of Age.”

National Center for Health Research: “Birth Control Pills: What You Need to Know.”

Canadian Medical Association Journal: “Contraception in women over 40 years of age.”

Breastcancer.org: “Is There a Link Between Birth Control Pills and Higher Breast Cancer Risk?”

Mayo Clinic: “Minipill (progestin-only birth control pill),” “ParaGard (copper IUD),” “Tubal Ligation,” “Vasectomy,” “Women’s Wellness: Do I Still Need Birth Control?”

Carcinogenesis: “Hormonal Carcinogenesis.”

UpToDate: “Etonogestrel contraceptive implant,” “Intrauterine contraception: Candidates and device selection.”

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