At What Age Should You Stop Birth Control?

Menopause typically occurs between ages 40-58, and the average menopausal age for women in the U.S. is 51. For some women, however, menopause can happen outside that range.

If you’re in your 20s it’s unlikely that you are in menopause even if you haven’t had a period in 12 months (it’s likely due to another reason).

But if you’re in your mid-40s or older and haven’t had a period in 12 months, you are quite likely in menopause. 

Although fertility starts declining around the age of 40, a woman can get pregnant at any time up until menopause.

While there’s no definitive test that can confirm menopause, your gynecologist can help you determine whether you are near menopause by reviewing your symptoms along with your medical and menstrual history.

With changing levels of hormones during perimenopause, you may experience symptoms such as:

• Heavy and irregular periods
• Hot flashes
• Vaginal dryness
• Sleep disturbances
• Mood swings

If you have been on non-hormonal birth control, menopause is highly likely if you are around 50 and haven’t had a period for 12 consecutive months. 

However, it can be difficult to determine whether you have reached menopause if you are on birth control pills. That’s because while birth control pills stop ovulation, you may have regular or occasional periods, or not at all, depending on other factors.

One way to find out if you are menopausal is to stop taking birth control pills after you reach age 50. Use a non-hormonal birth control method and see if you stop having periods for 12 consecutive months. 

Another option may be to stay on the pill until age 54. At this age, 90% of women have undergone menopause. 

Either way, you should talk to your doctor about what you plan to do.

After the age of 40, the same birth control methods you used when you were in your 20s and 30s may not be your best options anymore, depending on changes in your health. However, if you are healthy and don’t smoke, you may be able to continue using the same method you’ve relied on in the past. It’s best to review your contraceptive options with your doctor. 

If you are perimenopausal, you should avoid trying to use natural birth control methods such as tracking ovulation and periodic abstinence, because during this time your periods may be irregular and your ovulation unpredictable.

Birth control options for women over 40 include:

Barrier method

Barrier methods of birth control involve the use of physical barriers to block sperm. Different types of barriers include male or female condoms, diaphragms and spermicides. Condoms also provide some protection against sexually transmitted diseases.

Hormonal methods

Hormonal methods of contraception involve taking hormones on a regular basis and are a safe and reliable way to prevent pregnancy for many people. Hormonal birth control options use a combination of the two female sex hormones, estrogen and progesterone (progestogen). The synthetic form of progesterone is known as progestin.

Hormonal contraceptive options include:

• Combined oral contraceptive (COC) pills with estrogen and progestogen
• Progestogen-only mini-pills
• 3-month combined or progestin-only injections
• Progestin-only implants under the skin
• Vaginal rings inserted into the vagina which release a daily measured hormone dose, similar to COC pills
• Skin patches applied on the skin, which work similarly to COC

Intrauterine devices

Intrauterine devices (IUDs) are placed inside the uterus and are a long-term option that can last several years. Options include:

• Copper IUDs which creates a hostile environment for the sperm
• IUDs with levonorgestrel, a progestin

Permanent birth control

Permanent birth control through male or female sterilization may be an option for some. Surgical procedures include: 

• Tubal ligation or occlusion, in which the woman’s fallopian tubes are tied or blocked so the sperm can’t get into them.
• Vasectomy, in which the man’s vas deferens (sperm-carrying duct) is severed and sealed.

Emergency contraception

Emergency oral pills can be taken at any age, and as early as possible after unprotected vaginal intercourse or failure of contraceptive methods. IUDs inserted up to 7 days after intercourse are also an effective form of emergency contraception.

Combined birth control pills are safe for use for most healthy, non-smoking women until age 50. Progestogen-only birth control can be safely used until age 55, although women who have had breast cancer usually cannot take them. 

Estrogen-based contraception should be stopped at the following ages:

• 50 for healthy, non-smoking women with no medical problems
• 40 for women with cardiovascular disease or history of stroke or migraine
• 35 for women who are smokers

In addition to preventing pregnancy, birth control pills may be used to make menstrual cycles more regular and relieve perimenopausal symptoms such as heavy bleeding and hot flashes. Birth control pills can also help maintain bone strength and reduce the risk of ovarian and uterine cancers.

Hormone replacement therapy (HRT) uses very low doses of hormones and cannot replace birth control. 

If you have not reached menopause before starting HRT, you will need birth control until you are 55. An intrauterine system with levonorgestrel, which can also provide the progestin part of the HRT, may be a suitable option if you are on HRT and still need contraception.