Best Birth Control Options for Perimenopausal Women

The chances of getting pregnant during perimenopause are slim—but it’s certainly not impossible.

Women over the age of 40 still have around a 5% chance of getting pregnant during each menstrual cycle.¹ But if you’ve entered perimenopause before that, perhaps in your mid to late 30s, your chances could be higher.²

The bottom line? If you’re still getting your period—no matter how inconsistently or infrequently—you can still become pregnant because you’re still ovulating.³ So, if you’re approaching the menopause transition and aren’t looking to expand your family, it’s a great time to consider the best birth control options for perimenopausal women.

Let’s dive into a few.

What’s the Best Birth Control for Perimenopause?

If you’re trying to avoid pregnancy you may be wondering, what exactly is the best birth control for perimenopause?

This varies from woman to woman. The birth control option you ultimately choose will depend on your medical history, goals, and ability to use your chosen method as intended, for optimal efficacy.

For those with a history of breast cancer, stroke, or certain preexisting heart conditions, hormonal forms of birth control may not be the best option for you.⁴ This might also apply to those taking certain antidepressants, anti-seizure drugs, antibiotics, and other medications.⁵ It’s always best to speak with your healthcare provider about your health history and current medications you may be taking in order to determine the best birth control option(s) for you.

Perimenopause and Birth Control Options

Birth control usually falls into two categories — hormonal and hormone-free. In this next section we’ll review some of the more common types of birth control for women in perimenopause, in addition to their pros and cons.

Hormonal Birth Control

Birth Control Pills: Birth control pills contain hormones, like estrogen and/or progestin, that work to regulate menstrual cycles and suppress pregnancy – this type of contraception can come as a combined pill (containing both estrogen and progestin) or a progestin only pill.⁶ When taken consistently, birth control pills are 99% effective at preventing pregnancy and some may even help lessen symptoms like hot flashes.⁷

It’s important to note, however, that birth control pills do not protect against sexually transmitted infections (STIs) or diseases (STDs) and may carry a risk of complications, such as high blood pressure, heart attack, and stroke, in a small number of women who take the combination pill.⁸

Hormonal IUDs: Hormonal IUDs, or intrauterine devices, are a form of birth control that is inserted into the uterus, where they release a form of progestin. A hormonal IUD works by thickening the cervical mucus and preventing sperm from reaching and fertilizing eggs – it also prevents ovulation.⁹

A major benefit of hormonal IUDs is that, once inserted, they offer long-term pregnancy prevention, usually for three to 10 years, depending on the type.¹⁰ Additionally, they may lessen heavy menstrual bleeding and cramping.¹¹ Research on whether or not this type of IUD increases risk for breast cancer is ongoing, but some studies show a possible link between the two.¹² This contraception option does not protect against STDs or STIs.

Other Non-Oral, Hormonal Birth Control Methods: While the two above mentioned hormonal birth control methods are quite popular, several others do exist. These other birth control options release similar hormones as the intrauterine devices and oral birth control pills, but are delivered via:¹³

• injections
• skin patches
• vaginal rings

These other hormonal birth control options provide similar pregnancy protection benefits, but with less maintenance, as you won’t need to remember to take them daily. Both the skin patches and vaginal rings, for example, will need to be changed about every 3-5 weeks (depending on the method used) for optimal results.^14,15 These contraception options do not prevent against STIs/STDs.

Non-Hormonal Birth Control Options

Condoms:  When used correctly, condoms are about 95%-98% effective in preventing pregnancy and also offer some protection against sexually transmitted infections.¹⁶ However, condoms may lose effectiveness if they’re expired, don’t fit well or if they burst, tear, or slip off. Some lubricants may also degrade the integrity of condom materials, which may increase the risk of breakage.¹⁷

Sponges, Diaphragms, or Caps: Each of these forms of birth control are considered to be “barrier” contraception options. This means they are physically inserted into the vagina in order to block sperm from entering the uterus and fallopian tubes, where fertilization takes place.¹⁸

While barrier options, such as sponges, may already be coated in a spermicide (a chemical substance that works to kills sperm), you may need to use spermicide in addition to inserting other barrier options, such as a diaphragm or cervical cap, for added protection.^{19, 20}

The pros of these contraception options are that you won’t need to worry about possible hormonal side effects or risks, but you will need to be diligent about inserting the contraception correctly prior to each and every sexual encounter. These options will also not protect against STDs or STIs.

Copper IUD: Similar to hormonal IUDs, copper IUDs are a “set it and forget it” approach to contraception, that are placed within the uterus – this type of IUD, however, does not contain hormones. Instead, the device is wrapped in copper, which triggers a uterine immune response that creates a toxic environment for sperm.²¹

These devices are about 99% effective in preventing pregnancy, can last anywhere from 10-12 years, and are a potentially safer option for those living with a history of breast cancer.²² It’s important to note that copper IUDs also don’t protect against STDs – and some women may also experience heavier, or irregular bleeding when using this form of contraception.²³

Perimenopause and Birth Control Options

Most experts recommend using a reliable form of contraception until at least 12 consecutive months following your last menstrual period.²⁴ For many women, that means using a reliable form of birth control throughout perimenopause, until the age of 50-55.²⁵

Choosing the best birth control for perimenopause is a highly personal decision and is best made alongside a trusted healthcare provider. Together, you can consider all of the options available and choose a form of birth control that best supports your needs. 

Resources

1. https://www.webmd.com/baby/pregnant-at-40
2. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/age-and-fertility#
3. https://health.clevelandclinic.org/birth-control-during-perimenopause
4. https://www.aafp.org/pubs/afp/issues/2010/0915/p621.html
5. https://www.webmd.com/sex/birth-control/medicines-interfere-birth-control-pills
6. https://www.plannedparenthood.org/learn/birth-control/birth-control-pill/what-are-the-benefits-of-the-birth-control-pill
7. https://my.clevelandclinic.org/health/treatments/3977-birth-control-the-pill
8. https://my.clevelandclinic.org/health/treatments/3977-birth-control-the-pill
9. https://www.mayoclinic.org/tests-procedures/mirena/about/pac-20391354
10. https://www.yalemedicine.org/news/intrauterine-devices-iud
11. https://my.clevelandclinic.org/health/drugs/hormonal-iud-mirena
12. https://www.nejm.org/doi/full/10.1056/NEJMoa1700732
13. https://my.clevelandclinic.org/health/articles/11427-birth-control-options
14. https://www.mayoclinic.org/tests-procedures/birth-control-patch/about/pac-20384553
15. https://www.plannedparenthood.org/learn/birth-control/birth-control-vaginal-ring-nuvaring
16. https://www.who.int/news-room/fact-sheets/detail/condoms
17. https://my.clevelandclinic.org/health/treatments/9404-condoms
18. https://my.clevelandclinic.org/health/articles/23427-vaginal-diaphragm
19. https://my.clevelandclinic.org/health/articles/24324-birth-control-sponge
20. https://my.clevelandclinic.org/health/articles/17979-cervical-cap
21. https://www.yalemedicine.org/news/intrauterine-devices-iud
22. https://health.clevelandclinic.org/copper-birth-control
23. https://www.medicalnewstoday.com/articles/copper-iud#what-it-is
24. https://www.nia.nih.gov/health/menopause/what-menopause

25. https://www.cdc.gov/reproductivehealth/contraception/mmwr/spr/stop_using_contraceptives.html