No way, baby! Contraceptive needs in the perimenopause

A woman’s contraceptive choices and needs change over her lifetime.

While a woman’s fertility declines significantly after 40 years of age, reliable and safe contraception is still an important health issue.

An unplanned pregnancy at mid-life is a challenge that most of us would prefer to avoid – with one in four women who experience an unplanned pregnancy at this age choosing to have an abortion.[1]

Contraception for older women

Not only can life be more complicated at this age, but the medical risks for older mothers and their babies are also increased: with higher rates of fetal abnormality, miscarriage and premature delivery. [2]

A woman’s contraceptive choices are influenced by a number of factors: safety, accessibility, affordability, side effects, the desire to control periods, manage pre-menstrual mood concerns and replace hormones.

Hormone Replacement Therapy is Not Contraception

But a word of warning, ladies, hormone replacement therapy is not a method of contraception.

An experienced doctor should take the opportunity to raise the issue of changing contraceptive needs during the perimenopause, and use the framework of the UK Medical Eligibility Criteria (UKMEC) system to guide decision-making. The UKMEC provides an evidence-based approach to safe prescribing, with each potential risk factor considered and ranked according to their safety. Click here for more information. 

For example, women using the oral contraceptive pill need to be aware that as we age, the risks of clots in the legs and lungs increases. And that risk increase starts at 35 years of age. So much for 40 being the new 30…

Over 50 and Contraception Alternatives

Certainly, women over the age of 50 should not be using the oral contraceptive pill. At Wellend Health, we take the view that women should be reducing their exposure to the synthetic progestins in the oral contraceptive pill as much as is practical, with these hormones associated with an increased risk of breast cancer. [3]

So, this is where methods such as an Intrauterine Contraceptive Device (IUD) can be particularly helpful for women. IUDs are small, ‘T’ shaped devices that are inserted into the uterus in a procedure similar to a Pap test.

Now there are two types of IUD available: the Copper IUD and the Mirena IUD.

The Copper IUD is a non-hormonal method of contraception, but is associated with slighter heavier and more painful periods which tends to make it a less popular choice.

And the Mirena IUD releases a small amount of levonorgestrel (a synthetic progestin), providing both contraception and a reduction in periods over its 5-year life span.

Contraceptive choices IUD

The Mirena IUD can also be used as part of hormonal replacement therapy and is used to prevent endometrial polyps and hyperplasia (a build-up in the lining of the uterus) in women with breast cancer using tamoxifen. [4]

Studies show that the Mirena IUD is a well tolerated and popular choice among women of all ages, with 85% of women continuing with the IUD at the end of one year, compared with 60% of women continuing with the oral contraceptive at the end of one year. [5]

Dr Tonia Mezzini is an experienced IUD inserter. She has been inserting IUDs since 2008 and has been involved in training other doctors since 2010.

At Wellend Health, she uses this experience to ensure that women are choosing the right contraceptive method for their particular needs, and employs a range of medical options to ensure the insertion is comfortable and safe.

If it’s time to re-think your contraceptive choices and take positive steps to manage your health, make an appointment today with Dr Tonia Mezzini to discuss your particular needs.


[1] Scheil W, Scott J, Catcheside B. Pregnancy outcome in South Australia 2014. Adelaide: SA Health Pregnancy Outcome Unit. 2016.

[2] Kenny LC, Lavender T, McNamee R, O’Neill SM, Mills T, Khashan AS. Advanced maternal age and adverse pregnancy outcome: Evidence from a large contemporary cohort. PLOS ONE 2013;8(2):e56583.

[3] Marjoribanks J, Farquhar C, Roberts H, Lethaby A, Lee J. Long-term hormone therapy for perimenopausal and postmenopausal women. Cochrane Database Syst Rev 2017 Jan 17;CD004143.

[4] Dominick S, Hickey M, Chin J, Su HI. Levonorgestrel intrauterine system for endometrial protection in women with breast cancer on adjuvant tamoxifen. Cochrane Database Syst Rev 2015(12):CD007245.

[5] McNicholas C, Madden T, Secura G, Peipert JF. The Contraceptive CHOICE project round up: what we did and what we learned. Clin Obstet Gynecol 2014 Dec;57(4):635-43.


Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with: