Once you hit age 30, your fertility starts to drop. In general, your chances of getting pregnant without medical help is unlikely by age 45. But they’re not zero. You may still need to use a safe and effective birth control for longer than you think.
This is especially true if you don’t plan on having kids or want to avoid unplanned pregnancies. Experts recommend you use some form of birth control until you officially reach menopause.
Menopause means you’ve gone 12 months in a row without getting a period. But you may start to have the symptoms of perimenopause -- the months or years of transition leading up to menopause -- as early as your mid-30s or 40s. You can still get pregnant around this time.
As your fertility drops, your period cycle can change or fluctuate. “Natural family planning,” which depends on the timing of your cycle alone to avoid pregnancy, becomes a less reliable method of birth control as you age.
Birth Control Options at Midlife
You can choose from many types of birth control in this phase of your life. Some choices are permanent. Others use hormones, which are best only if you don't have any medical conditions that could put your health at risk. There are also options that don’t use hormones.
Your choices include:
Hormonal oral pills. These come in the form of combined estrogen-progestin pills or progestin-only pills. You can take them by mouth.
They work to:
- Stop or reduce your ovulation, the process by which your ovary releases an egg during each period cycle
- Thicken cervical mucus to stop sperm from entering your uterus
- Thin out the lining of the uterus to reduce chances of pregnancy
Before you take the combined oral pill, talk to your doctor to see if it’s OK for you medically. Generally, people with high blood pressure and diabetes are not supposed to take it. If you’re unsure, talk to your doctor.
Progestin-only pills, also called “mini pills,” are a good option if you can’t take estrogen because you’re breastfeeding or have a history of blood clots or strokes.
Non-oral hormonal birth control. If you don’t want to take pills by mouth, you can opt for other types of hormonal birth control, like a vaginal ring, skin patch, or shot. How you use each one varies. Ask your doctor before you switch to any of these.
Intrauterine devices (IUDs). This is a T-shaped plastic device a doctor inserts through your vagina and places in your uterus. It’s a quick and easy process. IUDs are a long-term option and can last 3-10 years to prevent pregnancy depending on the type of IUD.
You can choose either a hormonal IUD, which is coated with progestin, or a non-hormonal one, which is usually copper-coated. A progestin-coated IUD can help treat any heavy or irregular bleeding you may commonly have during perimenopause.
Barrier method. This includes non-hormonal options such as:
- Male and female condoms
- Spermicide
- Diaphragm with spermicide
- A cervical cap
- Spermicide sponge
These birth control options may be less effective at preventing pregnancies than pills. But condoms do provide protection against sexually transmitted infections.
Sterilization. This a permanent form of birth control. Women can opt for tubal ligation, a procedure that ties, cuts, or blocks your fallopian tubes. A vasectomy is surgery for men to stop them from being able to eject sperm.
Emergency birth control pills. These oral pills are commonly called the “morning after pill.” You can get them over the counter. You can use this method as a backup, in case your regular birth control fails, or if you don’t use any. Some options can be purchased over-the-counter, while others need a perscription. Depending on which you use, you’ll need to take this pill within 72 hours to 5 days after having sex.
Benefits of Hormonal Birth Control Pills
Besides being an option for birth control, hormonal pills you take by mouth can:
- Make your period cycles more regular
- Lead to less menstrual bleeding
- Lower your chance of iron deficiency and anemia
- Decrease uterine pain when you have a period
- Lower the risk of ovarian and uterine cancers
- Reduce hot flashes
- Keep up your bone strength
- Improve your acne (which can flare up around menopause)
- Stop unwanted hair growth
- Reduce migraines
Things You Should Know About Hormonal Birth Control
While it may give you a number of benefits, hormonal birth control can increase your risk for certain medical conditions such as a blood clot, heart attack, stroke, or breast cancer.
Before you take estrogen-containing pills, talk to your doctor. You should not use them if you smoke or have a history of estrogen-related cancer.
Because hormonal birth control options regulate your period if you have heavy or irregular bleeding, they may at times mask or hide symptoms of perimenopause or menopause.
Combined hormone pills can lead to something called withdrawal bleeding. This is when you bleed even after you’ve reached menopause. Withdrawal bleeding can make it hard for you or your doctor to figure out if you’re approaching menopause or already have it.
When to See a Doctor
If you notice any side effects from the birth control plan you’re on, tell your doctor as soon as possible. Before you switch or stop taking anything, it’s best to consult your doctor. They can direct you to other options.
Not everybody reaches menopause at the same age. The timing can vary anywhere from age 40 to 60. Every woman’s body is different, and there’s no test to confirm the loss of your fertility.
If you think you’re approaching menopause, or if you’ve missed your period for several months in a row, check in with your health care provider to confirm before you stop taking your birth control meds.
