Contraception is often perceived as unnecessary for women over 40, particularly those approaching menopause. However, until menopause is fully confirmed, contraception remains essential.
Menopause, defined as the absence of menstruation for 12 consecutive months, doesn’t occur overnight. Perimenopause, the transitional phase leading up to menopause, can last several years. During this time, hormone levels fluctuate, and while periods become irregular, ovulation can still occur unpredictably. As a result, the possibility of pregnancy, though reduced, still exists.
Though fertility declines with age, pregnancy after 40 is still possible and comes with increased risks. The likelihood of chromosomal abnormalities like Down syndrome is higher, and pregnancies at this age are often considered high-risk. These pregnancies may involve complications such as gestational diabetes, preeclampsia, and preterm birth. Using contraception ensures that women can avoid unintended pregnancies during this stage of life.
During perimenopause, irregular periods are common, and many women may assume they are no longer fertile. However, even if a woman has gone several months without a period, ovulation can still occur unexpectedly. Contraception acts as a safeguard against these unexpected ovulatory cycles.
Contraception after 40 offers additional benefits beyond preventing pregnancy. Hormonal birth control can help manage perimenopausal symptoms like hot flashes, mood swings, and heavy periods. It can also protect against certain reproductive health concerns such as ovarian and endometrial cancers.
To safely stop contraception, it’s important to confirm menopause. This can be done by tracking the absence of menstruation for a full 12 months, or by consulting a healthcare provider for hormone tests. Until this confirmation, women remain at risk of pregnancy and should continue using contraception.
Due to reduced fertility however any contraceptive method used is likely to be very effective, these can be barrier, contraceptive pill, intrauterine contraceptive devices or female/male sterilization.
(Author: Dr Ashwin Shetty, Consultant, Obstetrics and Gynaecology, Sir HN Reliance Foundation Hospital)
