Table of ContentsView AllTable of ContentsPregnancy After 40BenefitsRisksHealth ConsiderationsLifestyle ConsiderationsFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
Pregnancy After 40
Benefits
Risks
Health Considerations
Lifestyle Considerations
Frequently Asked Questions
Unless you are trying to get pregnant, you will likely need someform of birth controlin your 40s and 50s until you have fully transitioned tomenopause. While the same birth control method you used in your 20s and 30s may work just as well beyond those decades, there are some real age-related concerns regarding the use ofestrogen-containing birth control in some older women.
This doesn’t mean that you should abandonthe pillthe moment you turn 40 (particularly if you are sexually active), but rather that you work with your healthcare provider to consider the most appropriate birth control options as your body and sexual lifestyle start to change.
10 Common Myths About the Pill
Many women in their 40s and 50s will prematurely abandon birth control at the first signs ofperimenopauseunder the assumption that they are no longer fertile. In fact, of all age groups, research has shown that women over 40 are the least likely touse birth controlof any sort.
But until you are fully in menopause (meaning there have been 12 complete months without periods or even occasional bleeding), you still need to continue to access a reliable form of birth control if you want to prevent pregnancy.
Given this, it probably comes as no surprise that no less than 77% of women between the ages of 44 and 50 are at risk ofunplanned pregnancy, according to a 2016 analysis published in theAmerican Journal of Obstetrics and Gynecology.
Many women age 35 and older have perfectly healthy pregnancies and babies. That said, there are significant health risks in these women that are worth noting. These include the increased likelihood of preeclampsia, gestational diabetes, premature birth, and birth defects. This factors into some women’s decision to continue with contraception at this age and until menopause.
Benefits of Hormonal Contraceptives
For some women, continuing with the same method they’ve always used may be a reasonable option. It may even offer health benefits.
In the past, it was commonly believed that birth control options for women over 40 were limited to non-hormonal methods such as condoms,diaphragms, and eventubal ligation. Those views have changed considerably.
Today, research has shown that the benefits of oral contraceptives outweigh the risks and thatcombination birth control pillsare safe for most healthy women over 40.
In addition to preventing pregnancy, oral contraceptives can help:
Because modern birth control pills contain less estrogen andprogestin, they are considered safer than those of the past. This shouldn’t suggest, however, that they are the ideal choice foreverywoman over 40.
Common Causes of Birth Control Failure
Risks of Hormonal Contraceptives
While there generally are more pros than cons to the use ofhormonal birth control—whether as a pill,patch, orintravaginal ring—it may not always be the best option for women over 40.
One of the major concerns is that ongoing exposure to estrogen may increase the risk ofstrokeand thrombosis (blood clots) in older women. This includes life-threateningdeep vein thrombosis (DVT)andpulmonary embolism (PE).
Estrogen-containing birth control pills are also associated with a 20% increased risk ofbreast cancer, especially if taken for more than five years. High-dose estrogen andtriphasic pillspose the greatest risk overall. While it is unclear if estrogen-containing patches or rings can increase the risk of breast cancer, most experts believe the risk is low.
Does the Pill Cause Cancer?
As concerning as these risks may be, not every woman on oral contraceptives needs to change treatment the moment she turns 40. In most cases, an immediate change won’t be necessary.
As a general rule, you should discuss a change in oral contraceptives if you have an underlying health condition that places you at an increased risk of blood clots, liver injury, or certain cancers.
Some of these conditions are age-related and may not have been an issue when you were younger. Therefore, a form of birth control that may have been best for you in the past may not be so today.
Among the conditions and factors that contraindicate the use of ethinyl estradiol are:
Caution should also be used when prescribing estrogen-based oral contraceptives to women who areobese, as it can increase the risk of cardiovascular disease.
How Estrogen Affects a Woman’s Heart
Lifestyle also factors into the choice of birth control. After 40, your body will have changed, and there may be other, more appropriate options to consider. Habit alone cannot justify the routine, open-ended use of estrogen if, for example, you don’t have sex all that often.
To address these changes, many OB/GYNs will routinely wean their patients off estrogen-containing oral contraceptives after 40, moving them instead to the mini-pill or anintrauterine device (IUD).Vasectomyin a male partner could also be considered.
If it is suspected that women are going through the menopause, they are typically advised to stop taking the pill. Ifestrogen-replacement therapy (ERT)is needed, there are pills, patches, and creams that deliver estrogen at a far safer, therapeutic dose.
Best Options for Hormone Replacement Therapy
A Word From Verywell
Although oral birth control can be extremely safe and effective for women over 40, it is important to understand that there are some risks associated with its use.
To determine if the pill is the right choice for you, speak with your healthcare provider and be honest about anything that may increase your risk of harm during treatment, including smoking, previous cardiovascular events, or uncontrolled diabetes or hypertension. By working together with your healthcare provider, you can find the most appropriate ways to avoid pregnancy while protecting your long-term health.
Which Birth Control Method Is Most Effective?
Frequently Asked QuestionsYes. On average, women over 40 have a 5% chance of conceiving naturally with each menstrual cycle versus a 25% chance for a 30-year-old woman.Learn MoreHaving a Healthy Pregnancy After 40There are some risks associated with some types of oral contraceptives after age 40 that you should discuss with your healthcare provider. Contraceptives that have estrogen can increase the risk of conditions such as deep venous thrombosis and pulmonary embolism as well as stroke and myocardial infarction.The risk is specifically high for those with diabetes, hypertension, obesity, or migraine headaches.Learn MoreOptions for Natural Birth ControlSome healthcare providers may recommend using the mini pill after age 40 instead of other types of oral contraceptives. The mini pill is a progestin-only form of birth control. This type of contraceptive may have fewer side effects than regular oral contraceptives.The reduced risk of blood clots is especially important for women over 40 who may be at greater risk for clots.Learn MoreWhat You Should Know About Progestin-Only Pills
Yes. On average, women over 40 have a 5% chance of conceiving naturally with each menstrual cycle versus a 25% chance for a 30-year-old woman.Learn MoreHaving a Healthy Pregnancy After 40
Yes. On average, women over 40 have a 5% chance of conceiving naturally with each menstrual cycle versus a 25% chance for a 30-year-old woman.
Learn MoreHaving a Healthy Pregnancy After 40
There are some risks associated with some types of oral contraceptives after age 40 that you should discuss with your healthcare provider. Contraceptives that have estrogen can increase the risk of conditions such as deep venous thrombosis and pulmonary embolism as well as stroke and myocardial infarction.The risk is specifically high for those with diabetes, hypertension, obesity, or migraine headaches.Learn MoreOptions for Natural Birth Control
There are some risks associated with some types of oral contraceptives after age 40 that you should discuss with your healthcare provider. Contraceptives that have estrogen can increase the risk of conditions such as deep venous thrombosis and pulmonary embolism as well as stroke and myocardial infarction.The risk is specifically high for those with diabetes, hypertension, obesity, or migraine headaches.
Learn MoreOptions for Natural Birth Control
Some healthcare providers may recommend using the mini pill after age 40 instead of other types of oral contraceptives. The mini pill is a progestin-only form of birth control. This type of contraceptive may have fewer side effects than regular oral contraceptives.The reduced risk of blood clots is especially important for women over 40 who may be at greater risk for clots.Learn MoreWhat You Should Know About Progestin-Only Pills
Some healthcare providers may recommend using the mini pill after age 40 instead of other types of oral contraceptives. The mini pill is a progestin-only form of birth control. This type of contraceptive may have fewer side effects than regular oral contraceptives.The reduced risk of blood clots is especially important for women over 40 who may be at greater risk for clots.
Learn MoreWhat You Should Know About Progestin-Only Pills
11 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Guttmacher Institute.Contraceptive use in the United States.
Godfrey EM, Zapata LB, Cox CM, Curtis KM, Marchbanks PA.Unintended pregnancy risk and contraceptive use among women 45-50 years old: Massachusetts, 2006, 2008, and 2010.Am J Obstet Gynecol.2016 Jun;214(6):712.e1-8. doi:10.1016/j.ajog.2015.12.006
Allen RH, Cwiak CA, Kaunitz AM.Contraception in women over 40 years of age.CMAJ. 2013;185(7):565-73. doi:10.1503/cmaj.121280
Berg EG.The chemistry of the pill.ACS Cent Sci. 2015 Mar 25;1(1):5-7. doi:10.1021/acscentsci.5b00066
White ND.Hormonal contraception and breast cancer risk.Am J Lifestyle Med. 2018;12(3):224-6. doi:10.1177/1559827618754833
Delgado BJ, Lopez-Ojeda W.Estrogen. In: StatPearls.
American College of Obstetricians and Gynecologists.ACOG practice bulletin no. 206: Use of hormonal contraception in women with coexisting medical conditions.Obstet Gynecol.2019 Feb:133(2):e128-50. doi:10.1097/AOG.0000000000003072
North American Menopause Society.The 2017 hormone therapy position statement of the North American Menopause Society.Menopause.2017 Apr 6;24(7):728-53. doi:10.1097/GME.0000000000000921
USC Fertility.Advanced Maternal Age.
American Academy of Family Physicians.Progestin-Only Birth Control Pills.
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