Can you still use hormonal contraception in your 40s?

Fertility rates in women decline significantly in their late 30s. This is because women are born with around 1 - 2 million eggs, a number that reduces to about 400,000 by the time you start your periods. With each ovulation, hundreds of eggs are broken down and absorbed by your body, meaning only the healthy eggs survive. This means, your supply of eggs has significantly reduced by the time you're 30.

Studies show that women have a 20-25% chance of getting pregnant during each cycle at this age. Therefore, there’s still a chance, so it’s important you keep using contraception even in your 40s. However, women at this age require different guidance. This is because risks while using certain contraceptives are elevated as you get older.

Women can stop using contraception after a year since their last period, this is what is called the menopause. This happens because your hormone levels drop as you age, which causes your menstrual cycles to become irregular and eventually stop. This usually happens between 45 and 55 years of age.

If you’re already using hormonal contraception, it can be difficult to tell when menopause has happened as your hormone levels are affected. But, generally after the age of 55 your chance of pregnancy is very low, even if you’re still having periods.

The short answer is yes, women in their 40s can use hormonal contraception. In fact, it can have several benefits for women at this age who have irregular or painful periods. Although, hormonal contraceptives aren’t suitable for many women over the age of 35, and your doctor will discuss this with you before you choose to take one.

If you’re at a low risk of complications, each type of hormonal contraceptive can be taken safely depending on your age group.

You can use the combined pill, vaginal ring (NuvaRing), the contraceptive injection, or the contraceptive patch until the age of 50. According to FSRH Clinical Guidelines, the best contraceptive pill for women in their 40s is a combined oral contraceptive (COC) pill that contains a low dose of the synthetic oestrogen ethinyl estradiol (30mcg or less) as well as either the synthetic progesterone levonorgestrel or norethisterone. This includes combined pills such as combined pill/microgynon and Logynon. However, women aged 50 or over should not take the combined pill.

The mini-pill (progestogen-only pill) and the implant can all be used up until the age of 55. The intrauterine system (IUS) can also be used safely in your 40s and up until you’re 55. If you get an IUS inserted at 45 years old, you can leave it in until menopause. However, it should not be left in indefinitely as it can put you at a greater risk of infection.

You can also still use emergency contraception after unprotected sex if required.

How long you can take hormonal contraceptives for:

Can you use the IUD in your 40s?

While not a hormonal method of contraception, the copper intrauterine device (the copper IUD) can be used in your 40s. Like the IUS, it can be used and remain without being changed until after a year since your last period.

Hormonal contraceptive use in younger women does come with a low risk of serious complications. However, the longer you use them and the older you get, these risks become more prevalent, especially if you are using a combined oral contraceptive pill.

The main two risks you have to consider when thinking about hormonal contraception in your 40s are blood clots and cancer.

Blood clots

Blood clotting is a natural process in your body designed to heal blood vessels and prevent excessive bleeding. Typically these dissolve naturally as the injury heals. However, sometimes a blood clot forms inside an artery and doesn’t dissolve, which can potentially become a dangerous situation.

Abnormal blood clots most commonly occur in the leg, a condition known as DVT (deep vein thrombosis). The clot can also detach and travel to the lungs, critically limiting blood flow. This is known as a PE (pulmonary embolism).

Hormonal contraceptives can cause blood clots. In fact, some studies have found that they can increase the risk up to 9 times more than in those who don’t use it. However, research has found that age is also a significant risk factor for blood clots. So when combined with hormonal contraception, the risk is further elevated.

If you want to take an oral contraceptive pill and you’re over 35, your doctor will want to make sure that you’re not at risk of blood clots, such as if you:

• smoke
• binge drink
• have high blood pressure
• are overweight
• are at a high risk of cardiovascular disease, stroke or heart attack
• have a family history of blood clots
• have migraines

If you’re not sure if any of these medical conditions or factors apply to you, consult your healthcare provider.

Cancer

Hormonal contraception is also associated with an increased risk of certain cancers.

The most studied of which is breast cancer. Recent studies show that women who use a hormonal contraceptive, could be at a 20% higher risk of developing breast cancer than women who have never taken one. This risk increases the longer you take it, with women experiencing no elevated risk after 10 years of not using an oral contraceptive.

The other main type of cancer linked to hormonal contraceptive use is cervical cancer. Research shows that women who have used the pill for 5 years or less are at a 10% increased risk of cancer, with the risk doubling after 5 - 9 years of use. However, like with breast cancer, the risk gradually decreases after stopping oral contraceptives.

However, hormonal contraceptives do not increase the risk of developing all cancers. In fact, some research has shown that oral contraceptive use reduces the risk of developing endometrial, colorectal and ovarian cancer.

If you have a family history of breast or cervical cancer or are at a high risk of developing either, your doctor will likely advise against you taking a hormonal contraceptive. Irregular bleeding or unexplained vaginal bleeding may also be a sign of certain cancers, so your doctor will ensure you don’t have any symptoms before prescribing.

Even when you’re experiencing the first signs of menopause, (e.g. hot flushes, night sweats irregular periods or vaginal dryness), you can continue to take your hormonal contraceptive. This period of time is known as perimenopause, the natural transition into menopause.

In fact, taking hormonal contraception may help with menopausal symptoms and prevent complications such as osteoporosis. For that reason, in some cases, women under 50 years old may be prescribed a combined hormonal contraceptive as an alternative to HRT.

Can you take hormonal contraception with HRT?

Hormone replacement therapy (HRT) is usually the first line treatment for menopausal women. But if you still want to use hormonal contraception, there are some options available.

The IUS can be used alongside an oestrogen-only HRT to help protect the endometrial (uterus) lining. This is for women who have had a hysterectomy.

If you are taking sequential HRT, a form of HRT used for perimenopausal women who are still having periods, then you can use any progestogen-only method (e.g. mini-pill, the implant and the IUS).

You should always consult your doctor first when you start to notice signs of menopause, especially if you are using a hormonal contraceptive.

Just because you’re not able to get pregnant, does not mean you should stop using contraception. In fact, older women are still at risk of sexually transmitted infections (STIs). An article published by the charity Age UK reported a 13 - 23% increase in STI diagnoses in older people from 2014 - 2018.

The safest contraception methods for older women are barrier methods of contraception. These are devices that physically stop semen from entering the vagina, and can protect you from STIs. Barrier methods include:

• male condoms
• female condoms
• cervical cap*
• diaphragm*

*Do not reliably protect you from STIs.

You or your partner may also choose to get sterilised. For men, this procedure is known as a vasectomy, for women it's known as tubal occlusion. Both procedures are irreversible, meaning you will never have to worry about getting pregnant again.

However, it’s only generally considered for people over the age of 30 who have or are unlikely to ever have children. It’s a serious decision, so you should thoroughly discuss it with your doctor. This still also doesn’t protect you from STIs, so barrier contraception should be used where needed.