Contraception in Perimenopause: Yes, You Still Need It

TL;DR—If you’re still getting (even occasional) periods, you can still get pregnant. Keep using birth control until menopause is confirmed.

Perimenopause ≠ Infertility

Perimenopause is the long, bumpy runway that leads to menopause. Hormone levels swing, periods skip around, but ovulation can—and often does—still happen. A study in Fertility & Sterility found that women aged 40–44 have a natural pregnancy rate of about 10 % per cycle, dropping to 2–3 % by age 45–49. Those odds are low, but not zero. Surprise pregnancies (and the need for abortion or late-age parenthood) remain very real.

ACOG: Perimenopause FAQ

Why Avoid Pregnancy After 40?

Higher risk of miscarriage, pre-eclampsia, and gestational diabetes
Greater chance of chromosomal issues (e.g., Down syndrome)
Increased maternal complications like hemorrhage or C-section
You might simply be done with diapers

NHS: Pregnancy and older mothers

Birth-Control Options That Still Work

Method	Perks in Perimenopause	Cautions/Links
Combined Pill / Patch / Ring	Regulates cycles, tames hot flashes, protects bones	Avoid if you smoke (≥35 y) or have clot risk CDC MEC
Progestin-only Pill (“Mini-pill”)	Safe for migraine or clot-risk folks	Must be taken same time daily
Levonorgestrel IUS (Mirena®)	5–8 yr use, lighter periods, treats heavy bleeding	Insertion discomfort; tiny risk of expulsion
Implant (Nexplanon®)	3 yr set-and-forget, may reduce cramps	Irregular spotting
Depo-Provera® injection	3-month spacing, may reduce hot flashes	Can lower bone density—limit use to 2 yrs if risk factors
Copper IUD	Hormone-free, lasts 10 yrs	Periods may be heavier
Barrier methods (condoms, diaphragm)	No hormones, STI protection	Higher user-failure rates
Permanent: Tubal ligation or partner vasectomy	One-and-done	Surgical (you or partner)
Emergency contraception	Plan B up to 72 h; Ella® up to 120 h; Copper IUD up to 5 d	Weight can affect pill efficacy

Bonus: Symptom Relief

Certain contraceptives pull double duty:

Levonorgestrel IUS ➜ nearly eliminates heavy bleeding that often worsens in perimenopause.
Combined estrogen-progestin methods ➜ stabilize hormone swings, reducing hot flashes and mood shifts.
Progestin methods ➜ lower endometrial cancer risk.

When Can I Finally Ditch Birth Control?

Age 50 or older: keep contraception until 12 consecutive months without bleeding.
Age under 50: play it safer—24 consecutive months period-free.
Or confirm with two follicle-stimulating hormone (FSH) tests >30 mIU/mL taken 6 wks apart and no periods for 6 months.

Cleveland Clinic: Stopping contraception at menopause

Note: Hormonal IUS can mask bleeding, so discuss lab testing or ultrasound with your clinician before removal.

Red-Flag Situations—Talk to Your Clinician

New migraines with aura
Unexplained vaginal bleeding
Blood-pressure >140/90 on two readings
Personal or strong family history of breast, ovarian, or uterine cancer
Smoking + estrogen use after age 35

Quick FAQ

I’m on HRT; do I still need contraception?
Yes. Standard menopausal HRT doses won’t prevent ovulation.

Can I use my combined pill as HRT?
Sort of. It delivers higher estrogen than HRT, so you may switch to lower-dose HRT once periods stop, but contraception ends.

What about STIs?
Barrier methods remain your friend; midlife adults are a fast-growing group for chlamydia and gonorrhea. CDC data

Bottom Line

Until a healthcare professional confirms you’re officially menopausal, keep something between you and an unplanned pregnancy. Choose a method that suits your health profile and lifestyle, and enjoy sex—and midlife—on your own terms.

This guide is for general education only and does not replace personalized medical advice. Always consult your healthcare provider before starting, stopping, or changing contraception.