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Contraception for Women Over 40 — What You Should Know!

Updated: Nov 24, 2023

Various forms on contraception including birth control pills, IUD, purple diaphragm, vaginal birth control ring, birth control implant, red condom, the morning after pill, plan b, and arm implant are placed on a turquoise background.

You may hear a lot about preventive health if you’re over 40. There’s lots of news about how to watch for changing periods, and even some focus on perimenopause. As

you look at women’s health topics, not as much emphasis is placed on contraceptive options, and there's even less on sexually transmitted infections (STIs).

As a healthy woman over 40, let’s start at the very beginning with an exploration of contraception and which one is best. To gain further insight, Sophia Yen, MD, an outspoken advocate for #periodsoptional and the CEO of Pandia Health, a subscription contraception company, weighs in on which options are best and what we need to consider as we navigate through perimenopause and beyond.

What Are the Signs of Perimenopause?

Perimenopause means “around menopause.” It’s a time of natural transition, but it can be confusing because of menstrual irregularities and changing periods for women starting in their mid-30s into their 40s. Some of the earliest signs of perimenopause include hot flashes, weight gain, breast tenderness, and mood swings. With so much irregularity surrounding perimenopause, Dr. Yen recommends using birth control contraception to make the whole process easier, as well as protect from unintended pregnancy.

How Does Contraception Help With Perimenopause?

Dr. Yen says, “I actually think that women on the birth control pill who can stay on the birth control pill until about 50 are going to transition better because we have you on hormones.” Birth control makes the transition easier to deal with. It’s a good alternative to the constant uncertainty and the questioning, “Am I done yet?”

Dr. Yen says, “Rather than having unpredictable, crazy bleeding, let's just turn off your periods. A lot of women are coming back to birth control via the IUD, the implant, or the pill-patch-ring option, for your perimenopause state. It doesn’t need to be for birth control per se.” She adds, “The main concern is if you're above 35 and a smoker”, which increases the risk of blood clot.

Note that hormonal contraception may not be an option for women who have had certain kinds of cancer, such as breast cancer or endometrial, or uterine, cancer. It’s important to discuss these issues with your health care provider.

Why Do You Need Protection From STDs?

You still do need protection from STDs even when you’re over STDs. Age doesn’t prevent more than 2.5 million cases of chlamydia, gonorrhea, and syphilis. While it’s not something you probably want to think about as a 40+-year-old woman, it’s possible to “catch” an STD even if you’ve reached middle age. Even if you’re no longer on birth control, you still should use condoms plus spermicide.

So, why do we need to prevent STDs even at 40+? Untreated STDs can lead to infections, ectopic pregnancies, and lifelong infertility. While you may not be thinking or worrying too much about pregnancy right now, it’s still important to be protected.

Which Contraception Options Can You Use If You’re Over 40?

Sophia Yen, MD, says, “The best birth control is the IUD or the implant or vasectomy if you're willing and ready for that.” So, let’s start with that. Here’s what you should know about the various contraceptive options.

Hormonal IUDs

As Dr. Yen explains, “The IUD is an inter-uterine device. So you have your uterus, which is about the size of your fist. The device itself is literally thinner than my two fingers. It's two toothpicks that open up like a little umbrella. And the one with hormones secretes a very low dose of hormone only in your uterus.” The benefit is that 30% to 70% lose their period and, on the other side, the period becomes much lighter. Beyond the light or no-period benefit is that it’s “free, with no deductible.”

With so many benefits, there still are a few risks. Dr. Yen says that the main risk of the IUD could involve positioning that’s off, where the practitioner can’t figure out “how to straighten things out.” That positioning could cause them to pierce the uterus, which is more along the lines of sticking a tiny needle through your arm. It would probably hurt, but there would be no permanent damage. So, the birth control method would not work as expected, and the person could have an unplanned pregnancy. She also says, “There is a slightly increased risk of infection for the first 30 days.”

Depo-Provera Shot

As Dr. Yen says, “Then you have your option of the shot, which I generally don't recommend because it gives you the munchies, and it's not good for your bone density.” Still, if you’re looking for a birth control method that’s just a shot away, this might be a good option.

Pill, Patch, Or Ring

Dr. Yen says, “The only reason I would go on the pill, the patch, or the ring is that I'm a control freak.” With more than 40 options for pills, Dr. Yen says, “If this one doesn't get you to no periods, I'm pretty sure I can find one that gets you to no periods.”

Nexplanon Implant

The contraceptive Nexplanon implant is a small flexible plastic rod placed under the skin in your upper arm, which can last around three years. So, you get the progestogen that prevents pregnancy released directly into your bloodstream.

What’s Next?

If you’re looking for a homework assignment, Dr. Yen says, “Get your birth control under control. And then please demand menopause coverage of any FDA-approved method [if contraception] because it's ridiculous that we, because we’re older and women, have to fork out for this.”

The last question is simple: What one action will you take to optimize your health?

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