As we enter our 40s and early 50s, our contraception needs and priorities are often not the same as they were in our 20s. Perimenopause may happen alongside changes to your relationship or sex life, and the way you feel about pills, coils, injections or implants may change. Or you may want to find a method that does more to regulate or lighten your periods if they’re becoming problematic.
Perimenopause can be a good time to evaluate whether your familiar contraceptive method is still the best choice for you. When you consider your options, you should take into account your physical health, lifestyle and personal preferences.
But firstly, do you still need contraception anyway?
Can I still get pregnant in perimenopause?
If you are having sex with biological males, then the short answer is yes.
Fertility naturally declines as we get older but pregnancy although less likely, is still possible until menopause – and remember, that’s a whole year without periods.
Pregnancy after 40 also carries a higher chance of complications for both mother and baby. If you don’t want to become pregnant, it’s important to continue using contraception until it is no longer needed.
When can I stop using contraception?
Here are the key guidelines on when you can stop using contraception from the Faculty of Sexual and Reproductive Healthcare:
- If you are under 50 years of age, use contraception for at least two years, following your last period.
- If you are over 50 years, use contraception for at least one year following your last period.
- Most women can stop using contraception after the age of 55 years as pregnancy after this point is exceptionally rare, even if your periods have not yet come to an end.
(If you take HRT, don’t assume that the hormones in this must work as a contraceptive – the hormone levels are too low to function in this way.)
Does contraception just delay menopause?
Contraception does not delay or prevent menopause but it can mask the signs that you’ve entered perimenopause if you’re on a method that lightens or stops your periods, such as the hormonal coil. So if you don’t get periods because of your contraception, you won’t be sure when you have officially reached menopause.
Which contraceptive methods are suitable for women over 40?
The good news is that age alone doesn’t rule out most contraceptive methods during your 40s. Your overall health, medical history and risk factors are more important factors to help decide on the right method for you.
Here’s a summary of the different types of contraception and what to think about when making a decision:
Hormonal coils (or IUS)
Hormonal coils are among the most effective long-term contraceptive method (more than 99% effective). They are small T-shaped devices that are inserted into the womb and remain in place until they are removed, slowly releasing a steady dose of the hormone progestogen.
You may know them as:
– Mirena: this lasts up to 8 years for contraception (or used as part of HRT for 5 years) and treats heavy periods
– Levosert: lasts up to 8 years for contraception and used for heavy periods
– Benilexa: lasts up to 8 years for contraception
– Kyleena: lower-hormone dose option, lasts up to 5 years
– Jaydess: lower dose option, lasts up to 3 years
If you are over 45 years, some types of hormonal coil can often remain in place until age 55 if you’re just using it for contraception and not as part of HRT.
Copper coil (or IUD)
The copper coil is also a very effective contraceptive (more than 99%). Like the hormonal coil, it is a small T-shaped plastic device but it slowly releases copper – rather than hormones – into the uterus. If it’s fitted when you’re aged 40 or over, it can often remain in place until menopause without needing replacement.
If you’re not keen on taking hormones, this can be a good option however, it may not be the best choice if you have heavy periods, as it can sometimes make bleeding heavier, which is why it is generally used less than hormonal coils.
Progestogen-only pill (or ‘mini pill’)
The mini pill is a tablet that is swallowed daily and it remains a safe and effective option (more than 99%) for many women over 40 if used correctly and consistently.
It can lighten periods and is suitable for many women who cannot use estrogen-containing contraception such as the combined pill, which increases cardiovascular risks after 50.
Contraceptive implant
The implant is another highly effective long-acting method (more than 99%) and is a small plastic rod, around 4 cm long, that a doctor or nurse puts under the skin of your upper arm. It releases progestogen and stops the ovaries releasing an egg each month.
Research shows it does not increase the risk of blood clots or affect bone strength. It can usually be used safely throughout your 40s and into your early 50s if appropriate.
Contraceptive injection
The contraceptive injection is more than 99% effective if changed on time. They last between 8-13 weeks depending on the type, and are usually given by a doctor or nurse, and there is one type that can be self-administered at home.
They are not usually the first choice for women in their 40s as long-term use may affect bone density, so healthcare professionals recommend reviewing its use regularly. Women over 50 are usually advised to switch to another method if possible.
You can read more about Bone Health here.
Combined pill, patch or vaginal ring
These methods contain both estrogen and progestogen and come in the form of a pill, a sticky skin patch or a ring that sits inside the vagina. They can offer the following benefits during your 40s:
- lighter, less painful periods
- more predictable bleeding
- improvement in some menopause symptoms
- protection against ovarian and womb cancer that continues for many years after stopping.
However, they are not suitable for everyone. Women with certain medical conditions such as high blood pressure, migraines with aura (visual disturbances) or other risk factors may need an alternative because combined methods have an increased risk of cardiovascular events such as a clot or stroke for example). Read our guide on Keeping your Heart Healthy for more information.
Once you turn 50, it is generally advised you should stop combined hormonal contraception and change to a safer method. (Women who smoke should stop using combined hormonal contraception from age 35).
Barrier methods
Of course, there’s no reason why you can’t just use condoms and some women prefer this if they don’t want to take hormones in their contraceptive. There are also internal condoms for women that are loose pouches you insert inside your vagina.
Be aware if you’re using lubricants, oil-based lubricants can affect condom integrity so water-based lubricants are advised.
Some vaginal estrogen products may also not be compatible with effective condom use, such as Imvaggis, and Estriol 0.1% and 0.01% cream.
Condoms do have the added benefit of preventing sexually transmitted infections.
There are also diaphragm and caps that cover the entrance to the cervix and are often used alongside a spermicide. You can find out more about these methods here.
Note: Barrier methods are only effective when used correctly and consistently.
Permanent sterilisation
You may decide that you don’t want the inconvenience of remembering, organising and administering these other contraceptive methods and you’d rather a hassle free permanent solution.
You can usually get male and female sterilisation carried out on the NHS, and there are many private clinics that also offer this service. Female sterilisation usually involves a general anaesthetic and is a simple procedure that takes about 30 minutes and is performed by keyhole surgery, so you would only need to have 2 or 3 small holes cut near your navel. Parts of your fallopian tubes are blocked or removed and sealed. Male sterilisation, or vasectomy, involves local anaesthetic and takes around 30 minutes. The procedure stops sperm from being ejaculated by sealing, blocking or cutting the tubes that carry sperm to the penis.
HRT and contraception
Hormone replacement therapy helps relieve peri/menopausal symptoms but it does not prevent pregnancy. So if there’s any chance you could get pregnant, no matter how small, if this is something you don’t want, contraception remains vitally important throughout your perimenopause.
Some contraceptive methods, such as the hormonal coil, work particularly well during perimenopause because they minimise the inconvenience of irregular and heavy periods and protect the lining of the womb against the effects of replacement estrogen in HRT.
If you haven’t already, why not read more about HRT in our guide, Hormone Replacement Therapy.
Don’t forget about sexual health
Sexual health remains important throughout life, not just during your reproductive years.
Even if pregnancy is no longer a concern, sexually transmitted infections (STIs) can affect anyone who is sexually active, whatever type of sex you’re having and whomever it’s with.
If you have a new partner or are unsure of a partner’s STI status, make sure you’re following safe sexual practices. Read more information on sexual health advice here and if you’re after any tips to boost your sex life, take a look at our resource, Revitalising your Sex Life.
When should I see my doctor?
It’s worth making an appointment to discuss your contraception needs if you:
- have bleeding that’s much heavier or different from usual
- bleed after sex
- develop pelvic pain
- have bleeding after menopause
- want to review your contraception as you enter perimenopause
- are considering starting HRT.
Changes in bleeding are often caused by hormonal changes during perimenopause, but they should always be assessed to rule out other conditions. If you want to read more about bleeding in perimenopause, read our resource Unexpected Bleeding on HRT.
Making the best choice for you
The best contraceptive choice for you is one that aligns with your health profile, your lifestyle, preferences and habits. Have a conversation with your GP or local sexual health clinic to help ensure your method continues to be the safest and most suitable for you.
If you want to discuss contraception in light of your peri/menopausal needs and HRT treatment, you’re most welcome to book an appointment with us at Health in Menopause.
Last updated: August 2026
