You cannot know for sure you've reached the menopause when you're on the pill. This is because hormonal contraception can affect your periods. Menopause (when your periods stop permanently and you're no longer fertile) is usually diagnosed: These rules do not apply if you're taking hormonal contraception. In younger women, there are other reasons (apart from early menopause) why periods might stop, so discuss this with a healthcare professional if you're worried. If you're taking the combined pill, you'll have
monthly period-type bleeds for as long as you keep taking the pill.Bleeding if you're on the pill
If you're taking the progestogen-only pill, your bleeds may be irregular or stop altogether for as long as you keep taking the pill.
The combined pill may also mask or control menopausal symptoms, such as hot flushes and night sweats.
These factors can make it hard to know when you're no longer ovulating and therefore no longer fertile.
No menopause test
There is no test that can tell for certain whether you're in the menopause and can stop contraception.
There is a blood test to measure levels of follicle stimulating hormone (FSH) that can indicate if a woman is becoming menopausal. But this is not a useful test in women over 45 as FSH levels naturally go up and down at this time.
The FSH test is also not a reliable indicator that ovulation has stopped if a woman is taking the combined pill. It can be a helpful guide for women over 50 who are taking the progestogen-only pill.
Stopping contraception
All women can stop using contraception at the age of 55 as getting pregnant naturally after this is very rare. For safety reasons, women are advised to stop the combined pill at 50 and change to a progestogen-only pill or other method of contraception.
It is sensible to use a barrier method of contraception, such as condoms, to avoid getting sexually transmitted infections (STIs), even after the menopause.
Find local contraception services.
Page last reviewed: 1 July 2020
Next review due: 1 July 2023
- Contraceptive protection is still needed for women aged >44 years if the woman wants to avoid pregnancy.
Comments and Evidence Summary. The age at which a woman is no longer at risk for pregnancy is not known. Although uncommon, spontaneous pregnancies occur among women aged >44 years. Both the American College of Obstetricians and Gynecologists and the North American Menopause Society recommend that women continue contraceptive use until menopause or age 50–55 years (333,334). The median age of menopause is approximately 51 years in North America (333) but can vary from ages 40 to 60 years (335). The median age of definitive loss of natural fertility is 41 years but can range up to age 51 years (336,337). No reliable laboratory tests are available to confirm definitive loss of fertility in a woman. The assessment of follicle-stimulating hormone levels to determine when a woman is no longer fertile might not be accurate (333).
Health-care providers should consider the risks for becoming pregnant in a woman of advanced reproductive age, as well as any risks of continuing contraception until menopause. Pregnancies among women of advanced reproductive age are at higher risk for maternal complications, such as hemorrhage, venous thromboembolism, and death, and fetal complications, such as spontaneous abortion, stillbirth, and congenital anomalies (338–340). Risks associated with continuing contraception, in particular risks for acute cardiovascular events (venous thromboembolism, myocardial infarction, or stroke) or breast cancer, also are important to consider. U.S. MEC states that on the basis of age alone, women aged >45 years can use POPs, implants, the LNG-IUD, or the Cu-IUD (U.S. MEC 1) (5). Women aged >45 years generally can use combined hormonal contraceptives and DMPA (U.S. MEC 2) (5). However, women in this age group might have chronic conditions or other risk factors that might render use of hormonal contraceptive methods unsafe; U.S. MEC might be helpful in guiding the safe use of contraceptives in these women.
In two studies, the incidence of venous thromboembolism was higher among oral contraceptive users aged ≥45 years compared with younger oral contraceptive users (341–343); however, an interaction between hormonal contraception and increased age compared with baseline risk was not demonstrated (341,342) or was not examined (343). The relative risk for myocardial infarction was higher among all oral contraceptive users than in nonusers, although a trend of increased relative risk with increasing age was not demonstrated (344,345). No studies were found regarding the risk for stroke in COC users aged ≥45 years (Level of evidence: II-2, good to poor, direct).
A pooled analysis by the Collaborative Group on Hormonal Factors and Breast Cancer in 1996 (346) found small increased relative risks for breast cancer among women aged ≥45 years whose last use of combined hormonal contraceptives was <5 years previously and for those whose last use was 5–9 years previously. Seven more recent studies suggested small but nonsignificant increased relative risks for breast carcinoma in situ or breast cancer among women who had used oral contraceptives or DMPA when they were aged ≥40 years compared with those who had never used either method (347–353) (Level of evidence: II-2, fair, direct).