Contraception during Perimenopause and Menopause
Article written by Dr Mari Walling, British Menopause Society Registered Specialist, GP, Co-founder of Lemala Health, November 2025
This information is not a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare provider for personal guidance.
This guide explains your options, how long you need contraception, and how different methods work alongside HRT during perimenopause.
Many women are surprised to learn that contraception is still needed during perimenopause, even when periods are irregular or infrequent.
Although fertility naturally declines in your forties and fifties, pregnancy is still possible until menopause is confirmed.
Why contraception matters in Midlife
Perimenopause can last several years and ovulation becomes unpredictable. Even long gaps between periods do not guarantee that ovulation has stopped.
Most women reach menopause between 45 and 55, but some do earlier or later. Until your periods have stopped completely for the recommended time, contraception is still needed.
How long do you need contraception?
Age 55 or over: Contraception can usually be stopped regardless of bleeding pattern. Fertility is very unlikely after this age.
Over 50: Menopause is typically confirmed after 12 months without periods. This applies only if you are not taking hormones or using a hormonal intrauterine system.
Under 50: You need 24 months without periods before stopping contraception. Again, this applies only if you are not using hormones.
Does contraception affect menopause?
Contraception does not change the timing or duration of menopause. However, some methods can mask the early signs.
Some methods stop periods completely or give a regular artificial bleed, making it hard to tell where you are in the menopause transition.
Some methods help manage symptoms: Progesterone-only contraception can reduce heavy or irregular bleeding, while combined hormonal contraception can ease hot flushes and other menopausal symptoms.
Which contraceptive is best during perimenopause and menopause?
There is no single best contraceptive for women in their 40s and 50s. The right choice depends on:
How well it prevents pregnancy
Whether it protects against sexually transmitted infections (STIs)
How it is used
Possible side effects and health risks
Impact on your periods
Your medical history
Contraception can also help manage menstrual symptoms such as heavy bleeding, irregular cycles, and period pain. During perimenopause, some methods can reduce symptoms like hot flushes, night sweats, and mood changes by stabilizing hormone levels.
Types of contraception:
Non-hormonal contraception
Progesterone-only contraception
Combined hormonal contraception.
Non-hormonal and progesterone-only methods can be used alongside HRT. Combined hormonal contraception contains oestrogen and cannot be taken with HRT, though it may help with symptoms before transitioning to HRT.
Non-Hormonal Contraception
Copper coil
A copper coil is hormone-free and highly effective. It works for 5 to 10 years. If it is inserted after the age of 40, it can usually remain until menopause.
Periods may become heavier or more painful, so it may not be the best option if this is already an issue.
Condoms
Condoms are reliable and the only method that protects against STI’s.
Water-based or silicone-based vaginal lubricants are safe to use but avoid oil-based lubricants, as these can damage the condom and increase the risk of pregnancy or infection.
Fertility awareness
Not recommended during perimenopause due to unpredictable cycles and ovulation.
Progesterone-only contraception
Progesterone-only contraception includes the progestogen-only pill (POP), contraceptive implant, contraceptive injection, and hormonal intrauterine system. These methods contain a synthetic progesterone called progestogen. They are suitable for many women in their 40s and 50s and can often be used alongside HRT.
They are particularly helpful in perimenopause because they:
Lighten heavy periods
Reduce period pain
Provide reliable contraception
Progestogen only pill (POP or mini pill)
The POP is a tablet taken daily and used up to age 55. It is a good option for women who cannot take oestrogen. Many women find their periods become lighter or stop altogether.
Side effects such as headaches, nausea, acne or breast tenderness may occur when starting the POP but usually settle.
The POP can be taken alongside HRT for contraception, but it is not always suitable as the progesterone component of HRT, this depends on the brand etc and should always be discussed with your clinician.
Hormonal intrauterine system/ Coil (Mirena, Levosert, Benilexa)
The hormonal coil is a small device placed in the womb that releases a very low dose of levonorgestrel.
It is one of the most effective contraceptive options and can also be used as the progesterone part of HRT. It often makes periods lighter or may stop them altogether.
If being used as part of HRT, it needs changing after five years. If being used solely for contraception, then it can be used for eight years.
If inserted after age 45, it can remain in place until age 55 when used for contraception alone.
Some women experience irregular bleeding for the first three to six months. Side effects such as headaches, acne or breast tenderness may occur initially but usually settle.
Other hormonal coils such as Jaydess and Kyleena also release small amounts of progestogen and provide effective contraception but cannot be used as part of HRT.
Contraceptive implant
The implant is a small flexible rod inserted under the skin of the upper arm and provides contraception for 3 years. It is over 99 percent effective and does not contain oestrogen.
Bleeding changes are common. Periods may stop, become lighter, become irregular or occasionally last longer. Some women experience progestogen related side effects such as headaches or breast tenderness, usually in the first few months.
The implant can be used at the same time as HRT if contraception is needed, but it is not suitable as the progesterone part of HRT.
Contraceptive injection (Depo Provera or Sayana Press)
The contraceptive injection is given every 12 weeks and is an option for some women. It often leads to lighter periods and many women have no bleeding at all.
There are important considerations. It can affect bone density, so it is not usually recommended after age 50 or for women with risk factors for osteoporosis. Because the injection remains in the body for three months, any side effects cannot be reversed immediately. Side effects such as headaches, acne or breast tenderness may occur when starting treatment but often improve.
The injection can be used alongside HRT for contraception if needed.
Combined hormonal contraception (CHC)
CHC includes the combined pill or patch and contains oestrogen and progestogen. It cannot be taken with HRT.
CHC is commonly used in younger women, but after 40 it needs a safety review with a doctor. If you are 50 or over, it is recommended that you switch to a safer alternative.
CHC can help with some perimenopause symptoms such as irregular bleeding, heavy periods and hot flushes.
If you are under 50 and medically suitable, it can sometimes be used instead of HRT. However, CHC carries a higher risk of blood clots, stroke and heart disease, so it is not appropriate if you smoke over 35, have migraines or have certain health risks. There is also a small increase in breast cancer risk that does not persist once you stop.
If this article was helpful, explore our full library of menopause resources at Lemala Health