When helping women near menopause choose a method, consider:

Combined hormonal methods (combined oral contraceptives [COCs], monthly injectables, combined patch, combined vaginal ring)
  • Women age 35 and older who smoke—regardless of how much— should not use COCs, the patch, or the combined vaginal ring.
  • Women age 35 and older who smoke 15 or more cigarettes a day should not use monthly injectables.
  • Women age 35 or older should not use COCs, monthly injectables, the patch, or the combined vaginal ring if they have migraine headaches (whether with migraine aura or not).
Progestin-only methods (progestin-only pills, progestin-only injectables, implants)
  • A good choice for women who cannot use methods with estrogen.
  • During use, DMPA decreases bone mineral density slightly. This may increase the risk of developing osteoporosis and possibly having bone fractures later, after menopause. WHO has concluded that this decrease in bone mineral density does not place age or time limits on use of DMPA.
Emergency contraceptive pills
  • Can be used by women of any age, including those who cannot use hormonal methods on a continuing basis.
Female sterilization and vasectomy
  • May be a good choice for older women and their partners who know they will not want more children.
  • Older women are more likely to have conditions that require delay, referral, or caution for female sterilization.
Male and female condoms, diaphragms, spermicides, cervical caps, and withdrawal
  • Protect older women well because of women’s reduced fertility in the years before menopause.
  • Affordable and convenient for women who may not have sex often.
Intrauterine device (copper-bearing and hormonal IUDs)
  • Expulsion rates fall as women grow older and are lowest in women over 40 years of age.
  • Insertion may be more difficult due to tightening of the cervical canal.
Fertility awareness methods
  • Lack of regular cycles before menopause makes it more difficult to use these methods reliably.

 

Women Near Menopause