Contraception and cycle regulation in your forties

If you're in your forties, this one is for you. Maybe you aren't having kids, or maybe you've had them already. Maybe you've had a hot flash or two, or your period is a little irregular these days. Either way, menopause is still at least a few years away. 

If you're like others in this stage of life, you might wonder about your period. What's the point? Do you still need it? What are your options now that pregnancy is not part of your plans? We talked to Lisa Bayer, M.D., MPH., OB-GYN and contraception expert at the OHSU Center for Women's Health, to find out. 

There are two things to keep on your radar: contraception and regulating your menstrual cycle. 

Contraception 

"Many people think they can't get pregnant in their late forties," says Dr. Bayer. "But as long as you're ovulating, even if it's irregular, you can get pregnant." 

Dr. Bayer emphasizes that all the contraceptive methods available to people in their twenties and thirties are still options for most in their forties. The key is to talk to your provider, who can help you choose the right method for you. 

"Age alone doesn't change anything. If your blood pressure and cholesterol are normal, you don't smoke, and you aren't at risk for blood clots, there's no reason you can't keep using the pill, patch or ring you've used in the past," Dr. Bayer says. 

Longer-acting methods, such as intrauterine devices (IUDs) and the contraceptive implant, are great options. "If you're within five to ten years of menopause, these methods are as good as permanent, without any surgery," says Dr. Bayer. Neither of them contains estrogen, so they are safe for most people to use. 

If you're ready for something more permanent, tubal ligation is an option. Under general anesthesia, a surgeon will remove your fallopian tubes. Keep in mind though that there is risk, recovery time and expense associated with this surgery. If you have a male partner, a vasectomy is a great option for permanent contraception. 

Regulating your Cycle 

When you're not planning a pregnancy in the future, you may think your period is pointless. You're right.  

The whole purpose of your menstrual cycle is to prepare your uterus for pregnancy each time you ovulate. If you don't want to become pregnant, there's absolutely no health reason you need to have a menstrual period. Moreover, as you approach menopause, your periods can start to be more irregular and unpredictable.  

There are a wide variety of ways to regulate your cycle, including many of the contraceptive methods described above.

"IUDs like the Mirena or Liletta will make your period 80 to 90 percent lighter," Dr. Bayer says. "About a quarter of people using these IUDs will even stop having a period altogether." 

Other hormonal methods, like the pill, will make your period regular and predictable. Or skip the off-week with the pill and skip your period, too. After all, you don't need it. 

Another option for those who have heavy bleeding is endometrial ablation. This is a surgical procedure that can be done as an outpatient. "Essentially, it destroys the lining of your uterus so that it no longer grows and sheds," says Dr. Bayer. "It's fast, minimally invasive and thirty to forty percent of people who have the procedure will no longer have a period afterwards. The rest have much lighter bleeding." 

It's important to note that an endometrial ablation is not birth control. You can still get pregnant, and the pregnancy would be very high risk, so reliable contraception is critical after an ablation. 

If your menstrual cycle is changing, getting heavier or less regular, Dr. Bayer emphasizes that you should see your provider no matter what. "There are problems that get more common as we age, like fibroids or thyroid disorders, that can cause heavy or irregular bleeding. It's important to know whether you're just approaching menopause or there's another cause," she says.