Birth Control During Perimenopause and Menopause – What You Need to Know…

Dr. Alyssa Dweck

Written by Dr. Alyssa Dweck, MS, MD, FACOG, Chief Medical Officer

Who knew?

It seems unexpected pregnancy is not just an issue for teens. In fact, women transitioning towards menopause must consider the possibility of pregnancy, as well. Did you know a British woman was reported to conceive naturally at 58 years old and deliver a healthy baby at the impressive age of 59! While this is surely not common, it is a wake-up call.
 
First, let’s address the facts. By strict definition, menopause means twelve consecutive months of no menses, without another explanation. Menopause is a hindsight diagnosis. As such, contraception of some sort is recommended for those who want to avoid pregnancy until this occurs. This is truly surprising for many women to learn and yes, if your period shows up after eleven months, the “countdown to menopause” clock starts all over again.
 

Isn’t there a simple blood test for this?

Serum FSH (follicle stimulating hormone) and Estradiol levels are frequently requested and tested in order to “diagnose” menopause. These tests are not definitive, however. Although FSH typically rises (above 25IU/L) during the peri-menopausal transition, levels vary considerably throughout the process and cannot be relied upon. In addition, although the average age of menopause is 51, the range varies by several years in both directions and is influenced by both genetic and lifestyle factors.
 

What options are available?

Irregular and disruptive bleeding habits are common during perimenopause. Oftentimes oral contraception and hormonal IUDs can serve a dual purpose; regulating and managing flow and providing contraception. Oral contraception is typically considered safe in nonsmoking, healthy women up until the average age of menopause. This decision is of course made on a case-by-case basis. Condoms are an easy option particularly for the many perimenopausal women who are new in the dating world and also need protection from STIs (sexually transmitted infection). The rhythm method and natural family planning might be tricky with irregular cycles. However, post coital contraception such as the Plan B, morning after pill is always available in a pinch.
 

How will I know when I’m in menopause if I’m on the pill, have a hormonal IUD or have had a uterine ablation and don’t menstruate?

In these instances where menstrual bleeding habits cannot be used for assessment, menopausal symptoms such as hot flashes, age and blood testing, with FSH at a considerably high level (above 70IU/L) can be used to determine the need for contraception.
 
All in all, when it comes to contraception and perimenopause, it’s a gamble. You can play the odds or play it safe.

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