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What you need to know about fertility and perimenopause

It’s no secret that fertility changes with age. As we get older, especially after age 35, we’re less likely to conceive in any given cycle. 

But if you don’t want to become pregnant, being a bit older isn’t a reliable form of birth control. Even when your periods become irregular during perimenopause (the time before menopause), it’s still possible to conceive. So, until you’ve gone a full year without a period — which marks the official start of menopause — experts recommend a reliable form of birth control if you’re sexually active with someone who could get you pregnant.

There are a lot of birth control options to choose from, and a few important things to consider if you’re in perimenopause.

Common birth control choices in perimenopause

There are lots of popular birth control methods that work well at perimenopause: 

  • Hormonal oral contraceptives (the pill)
  • Hormonal injections, patches, or vaginal rings
  • Intrauterine devices (IUDs)
  • Sterilization, including tubal ligation or fallopian implants for women and vasectomies for men
  • Barrier methods, including diaphragms, condoms, and spermicides

Benefits and drawbacks of oral contraceptives at perimenopause

Oral contraceptives may come with a few extra perks if you’re having symptoms of perimenopause. In addition to preventing pregnancy, the pill can reduce hot flashes, regulate your cycle, and help prevent bone loss.

But it’s important to know that oral contraceptives might keep you from noticing the changes in your cycle that tell you when you’ve reached menopause. That’s because birth control pills may cause regular bleeding that seems like a period, even if you’re already in menopause. If you take oral contraceptives, make a plan with your doctor about how long you’ll keep using them. 

It’s also important to let your doctor know about your personal risk factors if you’re considering hormonal contraception, including cancer history, heart health, diabetes, and whether you’re a smoker.

The rhythm method (natural family planning) stops being effective at perimenopause

The rhythm method — tracking cycles to avoid sex during fertile days — doesn’t work well once perimenopause starts. That’s because cycles become irregular. Even with meticulous attention, it’s hard to predict when you’ll ovulate. 

If you use the rhythm method, it may be time to consider adding another form of birth control to your routine. 

What if you want to become pregnant?

If you’re begun perimenopause and you’d like to become pregnant, talk with your doctor about your risks and options.

The bottom line on fertility during perimenopause and beyond

Many people look forward to the time when they don’t have to worry about unplanned pregnancies anymore. But until menopause, you still have a chance of getting pregnant. So stick with a safe, effective method of birth control until you’ve reached that menopause milestone — 12 months without a period. 

Do you have questions about fertility, birth control, or menopause in general? Reach out to your provider for support.

Reviewed by the Ovia Health Clinical Team


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