Is the pill safe for people approaching menopause?

Taking the pill is a different proposition in your forties and beyond, but it doesn’t mean having to throw your pill pack away once you hit that milestone birthday.  

The combined oral contraceptive pill, commonly referred to as “the pill”, is the most popular form of birth control for women in the UK aged between 15 and 49 years, with 28 per cent using it as their main method. It contains artificial versions of oestrogen and progesterone—female hormones that your body creates naturally.  

Even if you’ve been on the pill for decades with no side effects, taking oestrogen does come with some caveats as you get older: there’s an increased risk of stroke, breast cancer and clotting in the legs or lungs—also known as venous thromboembolism VTE (which includes deep vein thrombosis and pulmonary embolism). These risks don’t apply to the progesterone-only pill. 

“But there is no age where you should just stop taking the pill,” says Dr Hana Patel, a GP specialist in women's health and mindset coach based in south-east London. “It’s down to the individual.” 

Your GP can give you personalised advice about taking the pill

However, no matter which form of birth control you’re using, it’s worth re-evaluating your contraceptive options at the start of your fifth decade.  

“As the risks of VTE increase significantly—and because we need to think about perimenopausal bone density—at the age of 40, all women should have an appointment with their GP to discuss their contraceptive choices,” said Dr Patel.

Your GP will then be able to steer you towards a birth control method that fits with this stage of your life. Doctors and nurses practising in England must follow the UK Medical Eligibility Criteria for Contraceptive Use (UKMEC) guidance, which allows them to weigh up the risks and benefits of every form of birth control against a long list of health factors.  

Age is only one factor. They also take into account others like your weight, if you smoke, your family and medical history, including whether or not you’ve undergone an organ transplant or bariatric surgery.  

“We then might find that there are other suitable methods of contraception a lady can be on,” says Dr Patel. “But if not, we have to be really sure that the patient knows that there's these increased risks now, because of their age.” 

So, what if your lifestyle suddenly changes too? For example, if you’ve recently come out of a relationship and don’t plan on having sex all that often. 

“I would say don’t be on the pill, then—don’t be on any medication if you don’t need to be,” says Dr Patel. She suggests using condoms or the hormonal coil instead, which only has a small amount of progesterone and doesn’t carry the risks that oestrogen does. 

It may be worth considering other birth control options

Lifestyle changes are what prompted Cath, 51, to give up hormonal birth control. After being on the pill from the age of 15 to 46 with no issues, she then switched to the implant, which she took out a year ago.  

“My new partner’s had the snip, so there’s no chance of me getting pregnant now,” she says. “Now I’m just trying to let my body get back to its natural state, but I’ve started having periods again. I actually wished I would have stayed on the pill, because I would have felt better.” 

If you take the pill according to its instructions, it’s more than 99 per cent effective at preventing pregnancy, which translates to fewer than one in 100 women falling pregnant in any given year. 

The pill has other perks too: it can decrease the risk of ovarian and womb cancer, reduce acne, make your periods lighter and, crucial for older women, combat the symptoms of perimenopause.  

“I originally took the pill to help with my heavy periods, but my mental health has improved alongside it too,” says Jackie, 41, who has been taking the pill on and off for six years, and is currently perimenopausal. “Without it, I’m way more irritable—before, I just couldn’t deal with people at work. I’ll definitely be on it now until I reach menopause, and then I’ll start taking HRT.” 

After consulting with your GP, you might find that the pill remains the perfect form of birth control for you.

If that’s the case, says Dr Patel, then you should be proactive about your health: check your blood pressure often, administer regular breast self-exams and report any unusual vaginal bleeding to your GP. She also suggests taking precautions when you fly, as that can increase the risk of a clot in the leg or lungs.

“And have in the back of your mind that there are other forms of contraception that might suit you better that don't have the risks,” she adds.

Read more: Ask the expert: What happens after menopause?

Read more: Which birth control pill is right for me?

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