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weir: is menopause birth control?

birth control messaging often leaves out women facing menopause.

by shirley weir

aug 21 2020

5 minute read

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shirley weir is the founder of menopause chicks

dear shirley,

i’m recently divorced and i find myself researching birth control methods for the first time in decades. i’m 48, in perimenopause and my periods are still fairly regular. how long will i continue to need birth control? what are my options? and is there a course on birth control for a woman in midlife?

great questions. there is definitely a gap in quality birth control education for women of all ages — so i love your idea for a course. there is a tendency in our society to focus birth control messaging on younger women, leaving out women who are navigating perimenopause-to-menopause with many of the same questions you have. you are not alone.

how long do i need birth control?

ask any woman about the benefits of post-menopause, and you are most likely going to hear that there are no more worries about becoming pregnant.

but what about women in perimenopause? there is quite a bit of confusion around contraception for women who have passed the family planning stage of life, but have not yet reached menopause.

let’s begin with a few definitions. menopause is one day. it is the 12-month anniversary of the final menstrual period. post-menopause is every day after the menopause milestone, for the rest of your life. perimenopause is the phase of life leading up to the menopause anniversary. it spans over a number of years — anywhere from five-to-fifteen — and is defined as a phase of life that includes fluctuating hormones. these fluctuating hormones can lead to changes in your period such as heavier or lighter bleeding, changes in the frequency of periods, or no changes at all — everyone is unique.

one of the most common experiences of perimenopause is skipping one or more periods, only to have it show up again a few months later. that is why the agreed definition of reaching menopause is 12 months period-free.

i frequently get asked, “how do i know if i have reached menopause?” the answer is that it doesn’t really matter — unless you are making decisions about birth control. every woman needs to know she can still become pregnant in perimenopause, and birth control is necessary.

what do the experts say?

to be clear, when it comes to preventing pregnancy, you are the expert on your own body. few women 45 and up are interested in becoming pregnant. and their doctors are especially wary of dealing with unplanned pregnancies.

for that reason, at the 2018 world congress on menopause , doctors recommended women who reach menopause — 12 months period-free — and are under the age of 50, should continue to use birth control for two additional years. and women who reach menopause after age 50 should continue birth control for one more year.

birth control options: new and old

there have not been that many new developments in birth control options for women since the pill made its debut in 1960. here is an overview of some of the current birth control options — be sure to talk to your health care professional to determine the option that is best for you.

non-hormonal birth control

vasectomy. this is my personal favourite, and i realize it is not an option for everyone, especially women starting new relationships. con: doesn’t protect from sexually transmitted infections (stis).

condom. covers the sti concern and can be used in combination with other methods. when using a lubricant, choose water-based as oil-based may cause latex condoms to break.

non-hormonal vaginal gel: next month, evofem biosciences is launching a new “on-demand” form of birth control in the usa and canada called phexxi . it’s a hormone-free, prescription gel known as a vaginal ph modulator. and it prevents pregnancy by maintaining a woman’s natural vaginal ph within the normal range of 3.5 to 4.5, which is an acidic environment that is not hospitable to sperm. similar to condoms, it is designed to be used in-the-moment, but can be administered up to one hour before intercourse.

hormonal birth control

birth-control pill. probably the most common choice, the birth control pill is a form of hormone therapy used by three-quarters of canadian women at some point in their lives between ages 15 and 49 to prevent pregnancy. advice as to whether the pill is right for you if you are over 49 is going to vary depending on your overall health, if you are a smoker/non-smoker and best left to an individualized conversation between you and your health care provider.

an iud offers a either a hormonal and non-hormonal option to birth control. the acronym which refers to intauterine device, is a t-shaped copper wire that fits inside your uterus and prevents sperm from reaching the eggs. an iud can contain hormones or be hormone-free. some women find that a hormone-based iud in perimenopause — the mirena is popular— helps manage heavy bleeding.

how to decide what’s right for you

birth control is a personal decision. make a checklist before discussing it with your health care team. it’s important to first decide where your personal values and preferences lie so you are prepared to either ask for what you want, or to say, “no thanks, that won’t work for me.” some questions to consider: am i at risk of getting pregnant? do i need protection from stis? have i reached menopause? am i under 50 or over 50? am i seeking short-term protection or a longer-term strategy? what is best for me at this point in my life — hormone-based or hormone-free?

it’s important to note that some practitioners look to the hormonal birth control options as ways to manage hormone imbalance during perimenopause, regulate periods, or manage acne. personally, i’m not a fan of this approach —especially if you don’t need birth control protection, or the pill is not already your preferred contraception method.

the pill, for example, is a uniform dose of hormones — whereas a woman’s natural hormones are fluctuating (sometimes wildly) in perimenopause. it’s rarely a perfect or personalized match. women should also be sure to weigh all the pros and cons of their decision and be aware that the birth control pill is known to cause vaginal dryness (how ironic) and deplete women’s bodies of essential nutrients, especially vitamin b.

do you have a question about perimenopause, menopause or beyond? post it in our private online community or write to me shirley@menopausechicks.com

shirley weir is the founder of menopause chicks, an online facebook community that advocates for women in perimenopause, menopause & beyond! she is also the author of mokita: how to navigate perimenopause with confidence & ease. @menopausechicks

weir: is menopause birth control?

birth control messaging often leaves out women facing menopause.

how long do i need birth control?

weir: women deserve a lifetime of healthy sex

weir: most women can't afford midlife health

what do the experts say?

birth control options: new and old

non-hormonal birth control

hormonal birth control

how to decide what’s right for you

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weir: is menopause birth control?

birth control messaging often leaves out women facing menopause.

how long do i need birth control?

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