I'm in my 40s and still have regular menstrual periods. What are my options for birth control?

Answer From Mary Marnach, M.D.

If you don't intend to have children in the future, one option is permanent sterilization for either you or your partner. Or if you're generally in good health — and you don't have any medical conditions that might make it risky to use them — hormonal forms of birth control may be an option, too.

Perimenopause birth control options include:

  • Combination estrogen-progestin pills or a vaginal ring, if you don't have a medical reason not to take contraceptive-strength doses of estrogen.
  • Progestin-only contraceptives, such as the levonorgestrel intrauterine device (IUD) (Mirena, Skyla, Liletta), the etonogestrel subdermal implant (Nexplanon) or the progestin-only minipill, which also provide protection from cancer of the endometrium — the tissue that lines your uterus. A progestin-containing IUD offers the added benefit of treating irregular or heavy bleeding that can happen with menstrual periods later in your reproductive years.
  • An estrogen-progestin skin patch, if you're not at risk of blood clots or other bleeding disorders. There may be an increased risk of blood clots when using the skin patch compared with other forms of estrogen-progestin contraception, such as birth control pills or the vaginal ring.
  • Barrier methods, including condoms, a diaphragm, a cervical cap or a contraceptive sponge, provide nonhormonal options for birth control. Condoms also protect against sexually transmitted infections. Barrier methods, however, are less effective than are other types of birth control.
  • A sterilization procedure, such as vasectomy or tubal ligation, which provides a permanent form of birth control.

Whichever method you choose, doctors generally recommend that you continue birth control for about 12 months after your menstrual periods naturally stop.


Mary Marnach, M.D.

April 18, 2020 See more Expert Answers

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