Contraception is an important issue for many women in years preceding menopause. Although fertility is decreased in the perimenopausal period, pregnancies do occur in women aged over 40 with increased risks of miscarriage, pregnancy related hypertension and diabetes and fetal anomalies.

There are several options available.

1. Intrauterine Device ( IUCD )
There are 2 options- the copper IUCD and the Levonorgestrel IUCD ( Mirena ). The Mirena IUCD has additional benefits of decreasing menstrual bleeding and cramps, and can also be used as part of hormone replacement therapy. However it cannot be used by women with abnormal unexplained menstrual bleeding or current breast cancer. The Mirena provides up to 5 years of contraception and the copper IUCD 3 years.

2. Contraceptive implant
This is a thin rod that is inserted in the doctor’s clinic just under the skin. It provides 3 years of contraception and can be used in smokers, overweight ladies or those with hypertension.

3. Combined oral contraceptive Pill ( COCP )
The COCP is licensed for used till 50, but is not advisable in women who smoke, have uncontrolled blood pressure or for those that have increased risk of stroke or cardiovascular disease. It is also not recommended in those who have a family history of blood clots and breast cancer gene mutations. The lowest dose pills should be used eg containing 20mcg of ethinyl oestradiol.

4. Progestrogen only pill ( POP )
The POP provides contraception by thickening cervical mucus and require to be taken in a 3 hour window daily. They may be less effective that the COCP but are safe for use in women who smoke, have hypertension or are overweight. However they may cause breakthrough bleeding and poor cycle control.

5. Surgical options
Considered more permanent options, for women the tubal ligation is a procedure done under a general anaesthetic to clip the Fallopian tubes. Failure rates are quoted at 0.1-0.5%. In men, the procedure is a vasectomy, a procedure done under local anaesthetic to seal off the vas deferens so as to prevent sperm from entering the urethra. Failure rates are quoted at 1 in 2000; protection is not immediate, at least 2 semen tests are needed to ensure that the remaining sperm have been cleared from the tubes.

Contraceptive choices are sometimes confusing and may seem complicated, but with careful consideration of all the important factors most women are able to find an option suitable for them till they reach menopause.