At what age should birth control pills be stopped?

According to the Centers for Disease Control and Prevention (CDC), women should continue using contraception until they reach menopause, typically between ages 50 and 55. Deciding at what age should birth control pills be stopped is a personal health choice made in consultation with a healthcare provider, balancing the continued need for contraception with potential health considerations in later reproductive years.

Quick Summary

Women can often safely take combined oral contraceptives until age 50 or 55, or until they have officially entered menopause, which is defined as 12 consecutive months without a period while not using hormonal birth control. The decision depends on individual health factors, such as smoking status and blood pressure, along with personal contraception needs and perimenopause symptom management.

Key Points

• Timing is variable: Most healthy women can continue combination birth control pills until age 50 or 55, often until menopause is confirmed.

• Consult your doctor: The decision should be made in consultation with a healthcare provider, who will assess individual health risks and needs.

• Know the risks: Taking combined hormonal birth control after age 40, especially for smokers or those with high blood pressure, increases the risk of blood clots, stroke, and heart attack.

• Consider alternative methods: For women over 40, or with certain risk factors, progestin-only pills, IUDs, or barrier methods may be safer alternatives.

• Understand perimenopause: Hormonal birth control can mask symptoms of perimenopause and menopause. Stopping temporarily under a doctor's care is sometimes necessary to determine menopausal status.

• Contraception is still needed: A woman can still get pregnant during perimenopause. Until menopause is confirmed (12 consecutive months without a period), contraception is needed to avoid unintended pregnancy.

• Benefits beyond contraception: For some women, especially those with perimenopausal symptoms like irregular periods or heavy bleeding, continuing birth control can provide relief.

Continuing Birth Control in Your 40s and 50s

Many women wonder about the safety and necessity of continuing hormonal birth control as they approach midlife. Fertility declines with age, but pregnancy remains possible during perimenopause—the transitional period leading up to menopause. This makes continued contraception a priority for many women looking to prevent unintended pregnancy. Major health organizations, including the American College of Obstetricians and Gynecologists (ACOG), advise that women can generally continue using combined oral contraceptives (COCs) until menopause, or until about age 50 to 55, provided they are in good health and do not have specific risk factors. However, careful consideration of potential risks and benefits is essential during this time.

Perimenopause, Menopause, and Birth Control

Perimenopause, which can begin years before a woman's final menstrual period, involves fluctuating hormone levels that can cause irregular bleeding, heavy periods, and other symptoms like hot flashes and mood swings. Birth control pills can be a useful tool for managing these symptoms by providing a steady dose of hormones, which helps regulate cycles and alleviate discomfort. It's important to understand that while taking hormonal birth control, the monthly withdrawal bleed is not a true period, and it can mask the signs of natural menopause.

How to Know When You've Reached Menopause on the Pill

Since hormonal birth control can mask the end of your natural cycle, determining if you've reached menopause while still on the pill can be challenging. A common strategy, especially for women in their 50s, is to stop taking the hormonal birth control under medical supervision to see if a natural period returns. Menopause is medically confirmed after 12 consecutive months without a period in the absence of hormonal medication. If you take this approach, it is crucial to use a non-hormonal form of contraception, such as condoms or a non-hormonal IUD, during this time to prevent pregnancy. Your healthcare provider may also use blood tests to check follicle-stimulating hormone (FSH) levels, though these can be unreliable while still on hormonal contraception.

Health Risks of Continuing Birth Control Past 40

While many healthy women can safely continue combined birth control, the risks for certain conditions increase with age, particularly after 40, and even more so after 50. The most significant risks are cardiovascular events, including:

• Blood clots: The risk of deep venous thrombosis (DVT) and pulmonary embolism (PE) increases with age and is further elevated by combined hormonal contraception.
• Stroke: This risk is higher for older women, especially those with other risk factors like high blood pressure, diabetes, or migraines with aura.
• Heart attack: Hormonal contraception can increase the risk of heart attack, especially in older women who smoke.

These risks are highest for women who smoke, have uncontrolled high blood pressure, or a personal history of cardiovascular disease or severe migraines. A healthcare provider will assess your individual risk factors to determine if continued use of a combined pill is appropriate.

Alternatives to Combination Birth Control Pills

For women over 40, particularly those approaching their 50s or with elevated health risks, other contraceptive options may be safer or more suitable. Some popular alternatives include:

• Progestin-only pills (mini-pill): These contain only progestin and avoid the estrogen that is associated with an increased risk of blood clots. They can be a safer choice for women with certain cardiovascular risk factors.
• Intrauterine devices (IUDs): Both hormonal (progestin-releasing) and non-hormonal (copper) IUDs offer highly effective, long-term contraception. The hormonal IUD can also help with heavy menstrual bleeding often experienced during perimenopause.
• Barrier methods: Condoms, diaphragms, and cervical caps are hormone-free options. While less effective than hormonal methods, they provide reliable contraception when used correctly.
• Sterilization: For women who are certain they no longer want children, permanent sterilization options like tubal ligation are highly effective and hormone-free.

Making the Decision with Your Doctor

Because the factors involved are so complex and individualized, it is essential to have an open and honest conversation with your healthcare provider. Your doctor can help you weigh the pros and cons based on your personal health history, lifestyle, and family planning goals. They can also discuss transitioning to different methods or hormone replacement therapy (HRT) if managing perimenopausal symptoms becomes the primary goal rather than preventing pregnancy.

Comparison of Contraception Options for Women Over 40

Method	Primary Hormone(s)	Typical Use until Age	Key Risks	Benefits	Notes
Combined Oral Contraceptives	Estrogen & Progestin	~50 (or 55) in healthy women	Increased risk of blood clots, stroke, heart attack, especially with smoking or hypertension	Regulates cycles, reduces heavy bleeding, manages perimenopause symptoms	Masks menopause symptoms, requires daily use
Progestin-Only Pill	Progestin	~55 or menopause	Less risk of blood clots compared to COCs	Suitable for women with estrogen contraindications, helps with irregular bleeding	Requires strict timing for maximum effectiveness
Hormonal IUD	Progestin	Up to 5-8 years of use	Low systemic risk, potential for spotting or irregular bleeding	Highly effective, long-lasting, can treat heavy periods	Offers non-contraceptive benefits and is easily reversible
Non-Hormonal (Copper) IUD	None	Up to 10-12 years of use	Heavier periods and cramping possible	Non-hormonal option, very effective	Long-lasting and can be used for emergency contraception
Barrier Methods	None	N/A	Variable effectiveness, requires user action	No hormonal side effects, can prevent STIs (condoms)	Good backup or primary method for lower-risk individuals

The Importance of a Healthcare Partnership

The final decision about when to stop taking birth control is a partnership between you and your healthcare provider. Your doctor can help you navigate the complexities of perimenopause, assess your health profile for any potential risks, and help you find a safe and effective path forward. Understanding your options and having regular check-ins will ensure you make the best choice for your health and well-being as you age. For more information on women's health throughout different life stages, you can visit the American College of Obstetricians and Gynecologists (ACOG) at acog.org.

Conclusion

While a common milestone for women approaching menopause, the question of when to stop birth control pills has no single answer. The typical timeframe is between 50 and 55, or after menopause has been confirmed, but this is subject to individual health factors and needs. With informed guidance from your doctor, you can navigate the transition through perimenopause safely and confidently, choosing the right contraceptive method or transition plan that aligns with your changing body and lifestyle.

Frequently Asked Questions

Can I continue taking birth control pills until age 55?

Yes, many healthy women can safely continue taking combined hormonal birth control pills until around age 55, particularly if they are non-smokers and have no other risk factors for cardiovascular disease.

How can I tell if I've reached menopause if I'm on hormonal birth control?

Since hormonal birth control can mask the symptoms and signs of menopause, the only definitive way to know is to stop taking the hormonal contraception. Menopause is confirmed after 12 consecutive months without a period in the absence of hormonal medication.

Are there health risks associated with taking birth control pills after age 40?

Yes, for some women, particularly those who smoke or have conditions like high blood pressure, taking combined hormonal birth control after age 40 can increase the risk of serious health issues such as blood clots, stroke, and heart attack.

What are the best alternatives to birth control pills for women over 40?

Suitable alternatives include progestin-only pills, hormonal or non-hormonal IUDs, and barrier methods like condoms. For women who are certain they do not want more children, permanent sterilization is also an option.

Do I need to stop birth control if I am still having periods in my late 40s?

No, you should continue using contraception if you are still having periods and want to prevent pregnancy. Until menopause is confirmed, fertility, though lower, is not zero.

Can hormonal birth control help with perimenopause symptoms?

Yes, hormonal birth control can effectively help manage the symptoms of perimenopause, including irregular periods, heavy bleeding, and hot flashes, by stabilizing hormone levels.

What is the next step after stopping birth control pills around menopause?

After stopping birth control and confirming menopause, some women may consider transitioning to hormone replacement therapy (HRT) to manage menopausal symptoms, which is different from birth control and not a contraceptive.

Does taking birth control pills delay menopause?

No, birth control pills do not delay menopause. They can, however, mask its symptoms, making it harder to determine when you have naturally entered menopause.

Is it safe to switch from combined pills to progestin-only pills in my 40s?

Yes, switching to a progestin-only pill can be a safer option for women over 40 who may have risk factors that make estrogen-containing pills less suitable.