Many women are aware that their fertility declines from their mid 30s and call up they can terminate using contraception in one case they are in their 40s. They wrongly presume – because their fertility is lower, they have less sex and their periods may have become irregular – that contraception can exist abandoned. However, women do still get pregnant in their late 40s and fifty-fifty into their 50s (without using assisted reproduction techniques), so contraception should continue to be used every time they have sex if pregnancy is to be avoided. Contraception should exist continued until menopause, which is defined as 2 years after the last natural menstrual period in women under age 50 and until one yr after the last natural menstrual menses in women over historic period 50. If menopause cannot be confirmed, contraception should be connected until age 55.

An unplanned pregnancy at any historic period can pose problems, but peculiarly so for a adult female in her 40s who may exist beginning to enjoy more than freedom as children grow upwards. Furthermore, a pregnancy in older women is often associated with an increased number of complications such as miscarriage, high blood pressure, diabetes and chromosomal issues with the infant, and consequently will need more careful monitoring.

In contempo years there have been many advances in contraception, and new methods may have additional health benefits (such every bit lighter periods) as well as providing fantabulous contraception. Women's needs change every bit they go older and a method that may not take been ideal when she was younger may become much more than suitable.

This fact sheet comments on various methods of contraception and discusses how appropriate they are for women in their 40s. Information technology should be read in conjunction with the more detailed fact sail on contraception available from the Women's Health Business concern.

Bulwark methods

Bulwark methods of contraception prevent sexually transmitted infections (STIs) and then are recommended for women with new sexual partners fifty-fifty if they have been sterilised or are using another method of contraception. Chlamydia, gonorrhoea, HIV and other STIs are on the increase in women in their 40s and 50s, so it is a expert thought to be screened for infection earlier starting a new relationship. At that place is no age restriction on barrier methods, which can exist continued until contraception is no longer needed (come across below).

The male prophylactic

This is an effective method for this historic period group, although some men may notice them hard if they have not used them for several years and may experience erection difficulties. As hormone levels alter many women feel vaginal dryness which tin cause discomfort during intercourse. Condoms are lubricated to make them easier to utilise. You should avert condoms with the spermicide nonoxinol-9 as this doesn't protect against STIs and has been linked to higher risk of HIV transmission so you should avoid this if you lot are at take a chance of HIV. Vaginal lubricants can be helpful, simply avoid oil-based lubricants as they can crusade latex and polyisoprene condoms to split, leading to a take chances of pregnancy and infection. Check with the chemist if you are using vaginal medication of thrush as some of these can besides harm latex and polyisoprene condoms. There is no interaction with oil-based lubricants or thrush treatments and polyurethane condoms.

The female prophylactic

Some women may find these bad-mannered if they have not used them before. They are well lubricated, and then vaginal dryness should not be a problem.

The diaphragm and cervical cap

Over again, some women may observe these awkward to use if they have not used them before, and if suffering from a pocket-size prolapse or stress incontinence may observe them uncomfortable. Spermicides are an inherent function of using a diaphragm or cervical cap and these will provide additional lubrication. Non toxic spermicide gels that prevent sperm motility are preferred.

Combined hormonal methods

Combined hormonal contraceptive methods (pill, patch and vaginal ring) are suitable until the age of fifty, then long as at that place are no health risks (e.thousand. smoking, obesity, high blood pressure) that could atomic number 82 to center, stroke or blood clotting problems. Your healthcare provider will exist able to advise on this.

Combined hormonal contraception has several advantages for women in this age group as information technology will regulate periods, may help to maintain bone mineral density (which is reduced after the menopause), may reduce claret loss and menstruum pains and may also salvage some troublesome menopausal symptoms such as hot flushes and dark sweats.

Progestogen-only methods

All progestogen-simply methods may cause irregular haemorrhage or even no bleeding at all. The absence of haemorrhage doesn't necessarily mean that you lot accept reached the menopause – it is just a side result of the method of contraception. Medical communication should be sought if bleeding occurs afterwards a long time with no periods.

The progestogen-only pill (POP or mini-pill)

The progestogen-only pill is a suitable method and can safely be used up until the historic period of 55, when contraception can exist stopped.

The contraceptive injection

There has been some business organisation that the injection may reduce os mineral density and increase the risk of osteoporosis. If you are over 40 and have lifestyle or hazard factors for osteoporosis (e.g. smoking, previous fractures, steroid use, family history), you are brash to consider a dissimilar method of contraception, many of which are just every bit constructive at this age. Otherwise, you can choose to go on this method until the age of 55 with regular review by your healthcare provider.

Contraceptive implants

The implant is a suitable method that can safely exist used up until the age of 55.

Intrauterine system (IUS)

The hormone-releasing IUS is a suitable method. As well as beingness a highly constructive method is has of import non-contraceptive benefits, significantly reducing period pain and bleeding. This is particularly of import every bit a considerable number of women complain of heavy periods and 'flooding' in their 40s. Additionally, if a woman decides to get-go HRT during the perimenopause, and then the IUS can exist used as the progestogen element of HRT.

The IUS is licensed for contraception for 5 years merely if it is inserted over the age of 45 years it can remain in place until the age of 55, when contraception is no longer needed. However, if you are using the IUS equally role of HRT, information technology will need to be replaced every v years.

Other contraceptive methods

Intrauterine devices (IUD)

An IUD is a suitable method but as it tin can crusade periods to go heavier or more painful, it may not be suitable if periods are already causing a problem. If an IUD (of any type) is inserted over the age of 40 years and then information technology can remain, without being inverse, until menopause.

Male and female sterilisation

Sterilisation (both male person and female) is a suitable method and is the most unremarkably used method for couples in their 40s. However, information technology is a not-reversible surgical procedure and is less effective than reversible methods such as the injection, implant and IUS, which have besides added not-contraceptive benefits for problem periods.

Natural family planning

Women who take already been using natural methods of contraception (timing of periods, changes in cervical fungus and body temperature) can usually proceed this method while they take regular periods. During perimenopause, variable cycle lengths and erratic ovulation makes this method unreliable.

Withdrawal

Although frequently used by couples in their 40s, withdrawal is not a reliable method of contraception.

Emergency contraception

At that place is no upper age limit for emergency contraception, which is indicated for any woman who still needs contraception who has had unprotected sex or contraceptive failure (a split prophylactic or missed pills). There are two forms: emergency contraceptive pills or the emergency intrauterine device (IUD).

Emergency contraceptive pills (levonorgestrel or ulipristal) can be obtained from your healthcare provider or from pharmacies without a prescription. The emergency IUD is the well-nigh effective method and has the reward that it tin remain in identify for ongoing contraception.

When to stop contraception

Contraception should exist connected for at to the lowest degree 1 year later your last menstrual menstruum if this was after the age of 50, and for two years if your periods cease before the age of 50. This is because sometimes periods may restart fifty-fifty after several months with no bleeding. Otherwise contraception can be stopped at the historic period of 55, even if you are even so having occasional periods, as the risk of pregnancy at this age is extremely depression.

However, if you are using progestogen-simply hormonal contraception you may well have but occasional periods or no periods at all, thus making it difficult to tell if you are menopausal. With the exception of the injection, progestogen-merely methods can exist safely used until the age of 55 years. Your healthcare provider may recommend a blood test which would give some guidance equally to how much longer you demand to proceed the method.

If using combined hormonal contraception you will experience regular periods or withdrawal bleeds which mask one of the signs of the menopause. Claret tests are non reliable and not recommended if you are using combined hormonal methods, which should be stopped at the age of 50, switching to an alternative non-hormonal or progestogen-only method.

Hormone replacement therapy

The boilerplate age for the menopause in the Uk is 51 years just women in their 40s may outset experiencing menopausal symptoms and consider taking hormone replacement therapy (HRT).

It is important to realise that HRT is not a method of contraception. If periods have non stopped before starting HRT and then a method of contraception should be used in addition to HRT. Suitable methods to consider would be barrier methods, an IUD, the progestogen-only pill or the IUS. Besides equally being an constructive method of contraception, the IUS has the boosted reward of providing the progestogen component of HRT and then minimises haemorrhage problems and other side-effects that might occur from the progestogen.

Once HRT has been started, it tin exist difficult to know when contraception can be stopped since HRT volition oftentimes produce regular monthly bleeds. It is best to continue contraception alongside HRT until the historic period of 55 when contraception is no longer needed.

This fact sheet has been prepared past Women's Health Concern and reviewed by the medical informational council of the British Menopause Society. It is for your information and advice and should be used in consultation with your ain medical practitioner.

Author: Professor Anne MacGregor in collaboration with the medical advisory council of the British Menopause Society.

Reviewed: November 2019

Next review due: November 2022

Women'southward Health Concern is the patient arm of the British Menopause Society

Registered Charity No. 279651

Website: www.womens-wellness-concern.org