Can you use hormonal contraception after 40?

Most hormonal contraceptive options available are generally safe to use when you are 40 or over. This includes short-term methods like pills and long-acting reversible contraceptives (LARC) like the IUD.

Each contraceptive method has its own age limit, but you can use them up until the age of 50-55 if you have no other health problems or risk factors and are still having periods.

Keep reading to learn each of their individual age limits, risks and benefits.

Combined hormonal contraception

Combined hormonal contraceptives (CHC) contain both oestrogen and progesterone and are available as “the pill”, the patch or the ring.

They are safe to use up until 50 years of age if you have no other medical problems or risk factors for side effects.

It has several benefits, which can make it a good option for women going through perimenopause.

It can increase the risk of complications such as blood clots, cancer and other health problems in certain women. So, you cannot take it if you:

• are a smoker (you must stop taking it by the age of 35)
• have a history of strokes or heart disease
• have a history of migraines with aura
• have any complications from diabetes (e.g. problems with your eyes, blood vessels or kidneys)

This is not a complete list. Your doctor will need to assess whether CHC is right for you to take.

Progestogen-only pill

Sometimes known as the “mini-pill”, the progestogen-only pill or POP. It is safe to use for women who cannot take CHC and can be used up until the age of 55.

It is safe for most women over the age of 40. It has a reduced risk of complications and can reduce pain in women with endometriosis.

However, if you currently have breast cancer, you cannot use the mini-pill. It also may cause irregular bleeding.

The implant

The implant is a small rod that is inserted under the skin in the arm. Once inserted, it can be left in for up to 3 years and can be used up until the age of 55.

Like the mini-pill, it only contains progesterone, which means it’s a safe option for women at risk of complications of CHC. It is also a very effective form of contraception, as you do not need to remember to take it.

It can cause irregular bleeding. If you are looking for more regular periods, you may want to try another form of contraception, such as CHC or the injection.

The hormonal IUD

The hormonal intrauterine device, or IUD, is another type of progesterone-only contraceptive. It is a small T-shaped device that is inserted into the womb.

There are several different brands of hormonal IUDs available, some effective for up to 8 years. This means if they are inserted before the age of 45, they can safely be used up until the age of 55.

The hormonal IUD is often recommended for women to reduce menstrual bleeding, pain and help treat endometriosis. There is also some evidence that it can help reduce the risk of womb cancer and ovarian cancer.

However, like the other progesterone-only methods, it cannot be used if you have current breast cancer.

The injection

The injection is another form of long-acting contraceptive that contains progesterone. You inject yourself, and it protects you from pregnancy for up to 13 weeks.

It has a few specific risks for women over the age of 40, which means it can only be used up to the age of 50.

One benefit of the injection is that it can reduce the risk of womb and ovarian cancer. Research has found it can also help improve heavy menstrual bleeding in perimenopausal women.

If you are at a higher risk of osteoporosis, you should not use the contraceptive injection. This includes if you are over 40 and:

• are a smoker
• are inactive
• have a family history of osteoporosis
• have a vitamin D deficiency

This is because it can reduce bone mass density, which may increase your risk of bone problems or injuries. While evidence suggests this effect reverses once you stop using it, it is still not recommended for those women.

As women get older, they have an increased risk of certain health conditions.

Hormonal treatments for contraception or for menopause symptoms can elevate these risks even more. So, treatment advice will be different for women over 40 than for younger women.

Blood clots and heart problems

The risk of cardiovascular disease increases after the age of 40 and after menopause.

Age can also significantly increase the risk of blood clots, also known as venous thromboembolism. 1 in 1,000 to 1 in 100 people aged over 40 experience a blood clot annually, according to Health Improvement Scotland.

Blood clots and heart disease can increase the risk of serious health problems, such as heart attacks and strokes. One study found that the risk of a stroke doubled every 10 years from the age of 45 onwards.

Hormonal treatments like contraception and HRT can sometimes increase the risk of blood clots and heart disease, so your doctor will need to assess the level of risk based on your own medical history.

Important

Lifestyle factors such as being overweight, being inactive, eating an unhealthy diet, smoking or drinking are also significant risk factors for blood clots. These will also impact your contraceptive options.

Cancer

The risk of getting certain cancers also increases with age.

Breast cancer is one of the most common cancers in older women. 80% of breast cancer cases are in women aged 50 or older. Other cancers that are common in women over 40 include womb cancer (endometrial cancer) and ovarian cancer.

Taking certain hormonal contraceptives and HRT can elevate these risks further, but others may reduce the risk. If you have other risk factors for cancer, your doctor will need to assess which contraception is best for you.

Bone health

Women post-menopause are at a higher risk of their bones weakening, a condition known as osteoporosis. This can make women more at risk of fractures.

Some contraceptives can increase your risk of osteoporosis, such as the injection. Others, like “the pill”, can improve bone mass density, which can reduce your risk of osteoporosis.

If you are particularly at risk for osteoporosis, your doctor will evaluate the risk.

Perimenopause is the period of time up until your last period. It generally starts from your mid-40s to early 50s, but can occur earlier for some women.

This is where most women will experience menopause symptoms such as hot flashes, spotting, mood swings and vaginal dryness.

Hormonal contraception can have several benefits during the perimenopause for regulating bleeding, reducing menstrual pain as well as providing contraception. It also can be combined with HRT in some cases for symptom relief.

Dr. Caroline Fontana Lead Prescribing Doctor

Certain hormonal contraceptives can improve certain menopause symptoms. They can particularly help with menstrual bleeding and pain, which is more common in women over 40.

For example, combined hormonal contraceptives like “the pill” are sometimes prescribed to perimenopausal women under the age of 50 to help with menopausal symptoms.

Hormonal contraception & HRT

Hormone replacement therapy (HRT) is a group of treatments available to help relieve menopause symptoms.

During menopause, your levels of oestrogen & progesterone start to fall, which is what causes symptoms. So, HRT works by balancing these hormone levels to treat symptoms.

You must still use contraception if you use HRT before the age of 55. HRT does not protect you from pregnancy. You can take most progestogen-only hormonal contraceptives alongside HRT.

The Mirena coil (a hormonal IUD) is also licensed to help protect your womb lining while using certain oestrogen replacement therapies.

If you are not able to use hormonal contraception, there are several safe alternatives available.

Women can still use emergency contraception if they still need contraception and have had unprotected sex. This includes the morning-after pill or the copper IUD.

Most women should stop using contraception once they reach menopause.

Menopause is the term used to describe a stage in a woman’s life where her periods stop permanently and she can no longer get pregnant.

This can occur:

• 1 year after periods have stopped (if over 50)
• 2 years after periods have stopped (if under 50)

Once you have reached menopause (are post-menopausal), you will no longer need hormonal contraception.

Important

You are still at risk of sexually transmitted infections (STIs) post-menopause. So, you should still use barrier contraceptives like condoms where needed.

It may seem like an overwhelming amount of information and factors to consider when choosing contraception after 40.

Take our handy quiz to find out which option is best for you.

Always consult your doctor before starting or switching contraceptives, especially if you have any preexisting health conditions.