As a GP, I often remind women that the best contraception depends on your age, health, lifestyle and your future. What worked for you at 16 may not suit you at later stages of your life.
Most importantly, contraception is about choice. It should fit your values, your lifestyle, and your health, not the other way around. So, here is my guide to contraception – from puberty to perimenopause – that explores their benefits beyond pregnancy prevention and disadvantages to consider.
Adolescence and early adulthood (puberty to mid-20s)
Starting your period and learning more about your body can mean it takes some time to develop confidence in making decisions about contraception. At this stage, contraception is often as much about controlling menstrual cycles and treating acne, as it is about avoiding pregnancy. Priorities to consider with the following options include safety, ease of use and reliable protection.
Combined hormonal contraception
Combined hormonal contraception contains two hormones, oestrogen and progesterone. It can help regulate periods, reduce period pain, and improve acne. It is available as a daily pill, a patch applied to the skin that is changed weekly or a vaginal ring that is changed monthly. Remembering to take the pill daily can be a big commitment.
Progestogen-only pill
Known as the “mini-pill”, the POP only contains progesterone and can be a great alternative for those who can’t take or tolerate oestrogen. It can help to reduce heavy or painful periods or stop periods altogether with long term use. This option requires stricter daily timing, as taking it at different times every day can cause irregular bleeding. It can also be associated with mood swings.
Contraceptive implant
This is a small rod containing progesterone that is inserted into the arm and works for three years. This option can be ideal for younger women who don’t want to take contraception daily.
Contraceptive injection
The injection is a method that slowly releases progesterone and is given every 8–12 weeks. It can also treat endometriosis, heavy and painful periods. However, long term use can reduce bone density, and fertility can take up to one year to return after the last injection. It can also be associated with a small amount of weight gain over time.
Condoms
Essential for protecting against sexually transmitted infections (STIs). I always advise combining barrier protection with another method if you’re not in a long-term relationship.
Late 20s to 30s
Many women in this stage of life are managing conditions such as fibroids or endometriosis, alongside contraceptive needs. You may also require flexible contraceptive that includes future family planning needs. Options include:
Hormonal coil (IUS)
This is a device that is inserted into the womb. It can make periods much lighter or stop them completely and is licenced to use for five years (or eight years if using the Mirena IUS) for contraception. This is hugely beneficial for women with heavy bleeding, anaemia, or conditions like fibroids. It also reduces pain and is often used to manage endometriosis symptoms. Fertility returns rapidly after it is removed, meaning the IUS can be a flexible option for many. Inserting the IUS has the potential to be painful, therefore it is important to discuss pain relief with your fitter. Some have also reported significant mood changes whilst using the IUS.
Copper coil (IUD)
A device that is hormone-free and can remain in place for five to ten years. This means it has no hormonal related side effects such as acne, mood swings or headaches, and fertility returns rapidly after it is removed. However, it can make periods heavier and more painful.
Combined hormonal contraception
This is still a useful option if you need to control your menstrual cycle to have regular, predictable bleeds, or have heavy/painful periods.
35 to 45 (midlife and perimenopause years)
This is a stage when your fertility is declining, but contraception is still necessary until menopause is confirmed. However, a careful balance between safety, controlling heavy or irregular periods and balancing hormones is needed when you consider the following options in this stage of life:
Hormonal coil (IUS)
This protects against pregnancy, controls heavy bleeding (a common issue for a woman in her 40s), and can be part of the progesterone component of hormone replacement therapy (HRT) in perimenopause.
Progestogen-only methods (pill, implant)
Often preferred after the age of 35, particularly for women who smoke, have migraines with aura, or other risk factors where oestrogen based contraception is less safe.
Barrier methods (condoms, diaphragm)
Still effective if used correctly, and condoms are important for STI prevention if starting new relationships.
Approaching menopause (45 and beyond)
At this stage, contraception can support a healthy and comfortable transition into menopause, improve heavy bleeding and be part of an HRT regime:
Hormonal coil (IUS)
This can stay in until menopause if fitted after the age of 45. It offers contraception, reduces bleeding, and provides womb protection as part of HRT.
Progestogen-only pill or implant
These are still safe options and can be continued into the late 40s and beyond.
Combined contraception
Combined contraception is usually not recommended beyond the age of 50 due to higher risks of blood clots and stroke.
When should I stop my contraception?
Menopause is confirmed if a woman has gone 12 months without a period over the age of 50, or 24 months if under the age of 50. It is difficult to know when you’ve reached menopause if you’re on hormonal contraception, since it can mask natural periods. Your GP may suggest a blood test to check hormone levels, especially if you’re over 50 and considering stopping contraception.
When to review your contraception
Your needs may change over time, so it’s worth reviewing your contraception with your GP if:
- You’ve developed new medical conditions (e.g. migraines, high blood pressure).
- You’re experiencing unwanted side effects.
- You’re entering a new life stage (e.g. thinking about pregnancy, approaching menopause).
- You’ve had a change in relationships or STI risk.
Contraception is not one-size-fits-all. The good news is that there are more safe and effective options than ever before, and your GP can help you navigate them.
