From the Guidelines
A menopausal woman can typically stop birth control at age 55, or after one year without a period if menopause occurs naturally after age 50, or after two years without a period if menopause occurs before age 50. This recommendation is based on the most recent evidence from the 2024 U.S. Selected Practice Recommendations for Contraceptive Use 1. The age at which a woman is no longer at risk for pregnancy is not known, and spontaneous pregnancies can occur among women aged >44 years.
Considerations for Stopping Birth Control
- The American College of Obstetricians and Gynecologists and the North American Menopause Society recommend that women continue contraceptive use until menopause or age 50–55 years 1.
- The median age of menopause is approximately 51 years in North America, but can vary from 40 to 60 years 1.
- No reliable laboratory tests are available to confirm definitive loss of fertility in a woman, and the assessment of follicle-stimulating hormone levels to determine when a woman is no longer fertile might not be accurate 1.
Risks Associated with Continuing Contraception
- Pregnancies among women of advanced reproductive age are at higher risk for maternal complications, such as hemorrhage, venous thromboembolism, and death, and fetal complications, such as spontaneous abortion, stillbirth, and congenital anomalies 1.
- Risks associated with continuing contraception, in particular risks for acute cardiovascular events or breast cancer, also are important to consider 1.
- Women with risk factors for blood clots or cardiovascular disease should consider switching from estrogen-containing contraceptives to progestin-only or non-hormonal methods after age 40 1.
Guidance for Healthcare Providers
- Healthcare providers should consider the risks for becoming pregnant in a patient of advanced reproductive age, as well as any risks of continuing contraception until menopause 1.
- U.S. MEC states that on the basis of age alone, patients of any age can use IUDs and hormonal contraception, but patients of advanced reproductive age might have chronic conditions or other risk factors that might render use of hormonal contraceptive methods unsafe 1.
From the Research
When to Stop Birth Control
A menopausal woman can stop using birth control when she has reached menopause, which is typically confirmed after 12 months of amenorrhea [ 2 ]. However, the decision to stop birth control should be based on individual circumstances and medical evaluation.
Factors to Consider
- Age: Women over 45 years old have a lower fertility rate, but pregnancy is still possible [ 2 ].
- Menstrual cycle: Women who have not had a menstrual period for 12 months are considered postmenopausal and can stop using birth control [ 2 ].
- Health status: Women with certain medical conditions, such as cardiovascular disease or diabetes, may need to continue using birth control to manage their condition [ 2 ].
Contraceptive Options
- Intrauterine devices (IUDs): IUDs are a highly effective form of contraception that can be used by women of all ages, including those in perimenopause [ 3 ].
- Hormonal contraception: Hormonal contraception, such as combined oral contraceptives, can be used by women in perimenopause to manage symptoms and prevent pregnancy [ 2 ].
Important Considerations
- Women who have not had a menstrual period for 12 months should still use contraception if they are sexually active, as pregnancy is still possible [ 2 ].
- Women who are using IUDs or hormonal contraception should have regular check-ups with their healthcare provider to monitor their health and adjust their contraception as needed [ 3 ].