Do I still need birth control during the menopause transition?

Kathleen D. Mahoney, MD
OBGYN (Obstetrics & Gynecology)

Absolutely. Believe it or not, the 'menopausal transition' can start in a woman's 30's!  For those women who stop having periods in their 40's, many started having perimenopausal symptoms in their 30's. Other physicians have already mentioned that women in their 40's falsely believe they can not get pregnant and that is certainly not true. As Dr. Oz has said, many of these pregnancies are not planned. What I do not see posted here is that pregnancies over the age of 40 are hi risk - both to Mom and baby. Certain birth defects and chromosomal problems such as Down's syndrome or trisomy 21 are much more common in babies born to older Moms.

Also, Mom is much more likely to develop complications such as diabetes as she gets older. Miscarriage is much increased as well. Many women have perfectly normal pregnancies in their 40's, and so I do not discourage most women in this age group from pregnancy. However, women and their partners should be aware of the risks involved and take appropriate preventative measures if they do not wish a pregnancy. That is true at any age!  Pregnancy over 50 (without help from fertility specialists) is exceedingly rare.

Paula Greer
Midwifery Nursing

Perimenopause actually occurs for the ten years prior to menopause. Menopause actually occurs when you have had no menses for one year.

During perimenopause your body goes thru many subtle changes. Your ovulation and periods may be more unpredictable. This irregularity does not mean that you wont fire eggs and wont have a sperm that finds one of them that results in a pregnancy. As long as you protect yourself adequately against unintended pregnancy you should be okay. Now is not the time to stop your birth control. If you have other health concerns that make taking hormones riskier for you be sure to share your concerns/options and discuss thoroughly with your health care provider.

Mary Lake Polan
OBGYN (Obstetrics & Gynecology)

Yes, birth control pills can be very helpful during the peri-menopause (transition from regular ovulation to menopause). First, although fertility rates decrease after the age of 40, you can't be sure you won't get pregnant so pills give you the security of contraception. Second, many women have heavy and irregular bleeding during this time and can become anemic from excess blood loss and pills can provide regular, light periods instead of heavy, irregular ones. And third, as you transition to menopause, it's important to develop strategies to avoid bone loss and pills provide enough estrogen to make up for any lack from your ovaries. So there are several reasons to continue birth control pills during the menopause transition.

Charla Simon
OBGYN (Obstetrics & Gynecology)
Although ovulation becomes unpredictable -- and statistically, women in their late 40s are less likely to conceive -- conception remains possible until menopause (1 year with no spontaneous cycles). So,yes -- you do still need contraception while you are transitioning.
Dr. Mehmet Oz, MD
Cardiology (Cardiovascular Disease)
A recent study shows that women over 40 are almost as likely to have unplanned pregnancies as 16-year-olds. Certain myths, like thinking you're too old to get pregnant, contribute to women over 40 getting pregnant.

Unless you have officially entered menopause, you need to use contraception, even if you've had infertility in the past. If you don't smoke or have any other risk factors, you can take the pill safely under the advice of your doctor. Women over 40 on the pill reap other benefits like treating perimenopausal symptoms, PMS, and fibroids.

This content originally appeared on
As we go through the menopause transition (sometimes called perimenopause), our hormones fluctuate and our menstrual cycles may become erratic. Some of us may think that we no longer can get pregnant, but this is not true, as the many unexpected pregnancies experienced by women in their forties prove. Per menopause can begin as early as our late thirties, but for most, it begins in their forties—as much as eight years before they reach menopause, which usually happens during the late forties or early fifties. While women are less likely to conceive as they grow older, the age at which women can no longer get pregnant varies. Because ovulation can occur right up to the last menstrual period, women who have sex with men and don't want to become pregnant should use contraception until one year after their last period.

Improved hormonal birth control methods such as low-dose combined oral contraceptive pills, progestin-only pills, implants, and the vaginal ring have fewer negative effects than hormonal contraceptives of the past, but each method has risks as well as benefits. Certain hormones can affect bone density, clotting, and vaginal lubrication in women nearing menopause. Barrier methods such as the diaphragm, the cervical cap, and the male or female condom don't affect the body chemistry but may not be as convenient or effective at preventing pregnancy. Improved intrauterine devices (IUDs) are now considered much safer than those that were available when many of us were first becoming sexually active. Options should be evaluated according to your individual needs and personal and family medical history.
Our Bodies, Ourselves: Menopause

More About this Book

Our Bodies, Ourselves: Menopause


Continue Learning about Birth Control

Is Over-the-Counter Birth Control the Best Bet for Women?
Is Over-the-Counter Birth Control the Best Bet for Women?
It’s always been easy to pop into your local pharmacy to pick up things like cosmetics, cotton balls and first aid supplies. And now, thanks to new l...
Read More
Can being overweight affect how my birth control pills work?
Univ. of Nev. School of Medicine, Family MedicineUniv. of Nev. School of Medicine, Family Medicine
Birth control pills generally work just as well in obese or overweight women. However, they may be l...
More Answers
How soon can I get pregnant after birth control?
Methodist Stone Oak HospitalMethodist Stone Oak Hospital
Stay on your birth control pills until you’re ready to get pregnant. Dependent upon your menstrual h...
More Answers
What Are the Different Options for Family Planning?
What Are the Different Options for Family Planning?

Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.