Do I Still Need Birth Control in Perimenopause?

Your period skipped two months. You’re 47, you’re having hot flashes, and you’ve assumed that’s that. Then it comes back, and you wonder if you can finally retire the condoms, or the pill, or whatever you’ve been using for twenty years. A friend of yours was surprised by a pregnancy at 46.

What counts as menopause

The OWH¹ defines menopause as having gone 12 months in a row without a period. It says perimenopause usually starts in the mid- to late 40s and lasts about four years on average, and that the average age of menopause in the US is 52. The NHS² says menopause and perimenopause are a natural part of life, happen when your periods change and eventually end because of lower hormone levels, and typically affect people between 45 and 55, though earlier is possible. See perimenopause and early menopause.

How long to keep using contraception

The sources differ a little, so ask your clinician which standard they follow.

• The OWH¹ says to continue until one full year after your last period.
• The Health Service Executive (HSE)³ in Ireland says to continue for 2 more years if you’re under 50 at your last period, and 1 more year if you’re 50 or older, and that you can end contraception entirely at age 55 because natural pregnancy becomes rare.

If your cycles are erratic, you can’t tell when “the last period” was until a year or two has passed. That’s why a skipped month isn’t a stopping point.

Hormonal birth control hides the signs

The HSE³ says that if you’re taking the pill, patch or ring, you may not know for sure if you’ve reached menopause, and that the pill can mask or control menopausal symptoms such as hot flushes and night sweats. It says an FSH blood test can help show whether contraception is still needed, but that the test can’t be trusted while taking combined hormonal contraceptives.

It also says only low-risk users can continue combined contraceptives between age 40 and 50, that they can’t be used over age 40 if you smoke or have a BMI over 30, and that they must be discontinued after age 50. Progestogen-only pills and barrier methods like condoms are alternatives. Your own clinician can help you choose what’s right for you.

What this means for you

If you’re in your 40s or 50s and not using contraception, you’re relying on irregular ovulation not happening. The OWH¹ says it can. For the symptoms around this time, see hot flashes, late or irregular periods and spotting between periods.

The play

Try this: a four-question list for your visit

1. When was my last period, and what’s my cycle been like?
2. Which method am I using, and is it still a good fit at my age and health?
3. If I’m on hormonal birth control, how will we know when I’ve reached menopause?
4. When can I safely stop, based on your guidance?

Write down the date of your last period before you go. If you track your cycle in an app, bring the record.

When to get checked

The NHS² says to talk to a GP about menopause symptoms and what may help. Ask about contraception at the same visit.

Book an appointment if any of these fit:

• You’re in your 40s or 50s, your periods are changing, and you don’t want to get pregnant
• You’re using hormonal contraception and wondering if you’re postmenopausal
• You smoke, or have a BMI over 30, and take a combined pill
• You’ve missed a period and aren’t sure it’s menopause
• You’re thinking about stopping contraception

If you’ve missed a period and think you may be pregnant, take a test.

Missing a month is a hint, and a year without one is the finish line. Surprises happen in between.