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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. A doctor can review your contraception, plan it around HRT and tell you when to stop by video; coil and implant fittings are in person.
- Still possible: over a year of unprotected sex, about 10 to 20 in 100 women aged 40 to 44, and about 12 in 100 aged 45 to 49, become pregnant.
- When to stop: without hormonal contraception, after 2 years with no periods if you are under 50, or 1 year if you are 50 or over; everyone can stop at 55.
- HRT is not contraception: it does not prevent pregnancy, but a larger hormonal coil can protect the womb lining during HRT and prevent pregnancy at the same time.
- Emergency: call 112 for sudden, severe pain low in your tummy with a missed period or a positive pregnancy test, which can be an ectopic pregnancy.
Call 112 if you have sudden, severe pain low in your tummy with a missed period or a positive pregnancy test. Bleeding after sex, between periods, or after your periods had stopped for a year needs a doctor’s check soon, whatever contraception you use.
Can an online doctor help with contraception in perimenopause?
Yes, usually. Contraception over 40 is mostly about choosing the right method for your age and health, fitting it around HRT, and knowing when you can stop. A doctor can go through this by video and prescribe a pill where it suits you. Coil and implant fittings, examinations and scans are done in person, and the doctor tells you where.
How an online consultation helps with contraception in perimenopause
- Is it still needed?: Your age, your periods and your method decide whether you still need contraception.
- The right method now: Which methods are safest over 40 and over 50, and which also help heavy periods or hot flushes.
- Contraception and HRT: Which methods work alongside HRT, and the one that can be part of it.
- When to stop: A clear plan for your method, and what changes at 50 and at 55.
What the doctor checks in an online consultation about contraception in perimenopause
The doctor asks about any warning signs first, then about your periods, your method and your health. The doctor asks about:
- Warning signs: bleeding after sex, between periods or after your periods had stopped, tummy pain, or a possible pregnancy.
- Your periods: how they have changed, whether they are heavy, and the date of your last natural period.
- Your method: what you use and since when, because some methods change at 50 and at 55.
- Your health: blood pressure, smoking, weight, migraine with aura, blood clots, heart disease, stroke and breast cancer.
- Menopause symptoms: hot flushes, sleep and mood, and whether you use or are considering HRT.
Before the call, note the date of your last natural period, when your current method was started or fitted, and a recent blood pressure reading if you have one.
Can you get pregnant during perimenopause?
Yes. Fertility falls through your 40s, but you can still ovulate, sometimes unpredictably, until the menopause. Over a year of unprotected sex, about 10 to 20 in 100 women aged 40 to 44 become pregnant, and about 12 in 100 aged 45 to 49. Pregnancy without fertility treatment is rare after 50 and exceptionally rare after 55, which is why contraception is needed until the menopause or 55.
Is it dangerous to get pregnant during perimenopause?
Pregnancy after 40 carries higher risks for you and the baby. Miscarriage becomes much more common, affecting more than half of pregnancies over 45, an ectopic pregnancy is nearly 3 times as likely as at younger ages, complications for mother and baby are more common, and chromosomal conditions such as Down syndrome become more likely.
How do you know when you are in perimenopause?
Perimenopause is the time, often lasting several years, when periods become irregular before they stop. The menopause is your last period, confirmed after 12 months without one. Contraception does not change when the menopause happens, but hormonal methods can hide the signs because they change your bleeding. Blood tests of hormone levels are unreliable during perimenopause and are not used to decide when to stop, except in some women over 50 using a progestogen-only method.
The menopause page covers symptoms and treatment.
Which contraception is best over 40?
Most methods are safe over 40, and the best choice depends on your health, your periods and how long you need it for. The main change is with combined methods (the combined pill, patch and ring): the small risk of blood clots, heart attack and stroke rises with age, so they are used only until 50, and usually not at all if you are 35 or over and smoke, have high blood pressure, or have migraine with aura.
Swipe sideways to compare →
| Method | Can usually be used until | Worth knowing over 40 |
|---|---|---|
| Copper coil | The menopause, if fitted at 40 or over | No hormones; periods can become heavier |
| Hormonal coil | 55, for some types fitted at 45 or over | Lighter periods; can be part of HRT |
| Implant | 55 | Bleeding can be unpredictable |
| Progestogen-only pill | 55 | Suits most health conditions |
| Injection | 50, then usually a switch | Bone density falls while you use it; reviewed every 2 years |
| Combined pill, patch or ring | 50, if nothing in your health rules it out | Can ease hot flushes and heavy periods |
| Condoms or a diaphragm | Any age | Less effective; condoms protect against infections |
| Sterilisation or vasectomy | Permanent | Long-acting methods are as effective |
If you have migraine with aura, combined methods are not routinely offered, but progestogen-only and non-hormonal methods are usually fine. See migraine with aura.
Contraception and HRT: do you need both?
Often, yes. HRT is not contraception: it uses similar hormones, but not at levels that stop you getting pregnant. If you might still be fertile, you need contraception as well.
- Progestogen-only methods, such as the pill, implant, injection and hormonal coil, are safe to use with HRT.
- The larger hormonal coils can also be the progestogen part of HRT, protecting the womb lining while giving contraception. Used this way, the coil is replaced every 5 years.
- The progestogen-only pill, implant and injection do not protect the womb lining when you take oestrogen, so you still need a separate progestogen with oestrogen HRT.
- A combined method can be used instead of HRT under 50 to ease menopause symptoms, if it suits your health.
- A copper coil or condoms can be used with any type of HRT.
When can you stop contraception?
It depends on your age and your method:
Swipe sideways to compare →
| Your situation | When you can usually stop |
|---|---|
| No hormonal contraception, under 50 | After 2 years without a period |
| No hormonal contraception, 50 or over | After 1 year without a period |
| Copper coil fitted at 40 or over | Taken out 2 years after your last period if under 50, or 1 year after if 50 or over |
| Combined pill, patch or ring | Switch at 50 to a progestogen-only or non-hormonal method |
| Injection | Usually switch at 50 |
| Implant, progestogen-only pill or hormonal coil | Can be continued until 55; over 50, a blood test can sometimes show you can stop earlier |
| Everyone | At 55, even if you still have periods |
A coil should not be left in once you no longer need it, so plan its removal with your doctor or nurse.
Can contraception help with perimenopause symptoms?
- Heavy periods: the hormonal coil greatly reduces bleeding, and combined methods can make periods lighter and less painful.
- Hot flushes: combined methods may help, particularly when taken without a break.
- Bones: combined methods may help keep bone density in perimenopause. The injection causes some bone loss while it is used, which is why it is reviewed and usually stopped at 50.
- Period pain: the hormonal coil, the implant and a desogestrel progestogen-only pill may reduce it.
Contraception does not delay or bring forward the menopause. If symptoms are troublesome, the doctor can talk through HRT and how it fits with your method.
What might the doctor recommend about contraception in perimenopause?
This is the framework the doctors use:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Over 40 on the combined pill, patch or ring | A check of blood pressure, smoking and migraine, and a plan to switch by 50 | Yes | For a coil or implant if you switch |
| Irregular periods and no contraception | Contraception until you meet the stop rules, and emergency contraception if needed | Yes | For a coil fitting |
| Starting HRT and still having periods | A method that works with HRT, often the hormonal coil | Yes | For a coil fitting |
| Turning 55, or a year without periods at 50 or over | A plan to stop, and coil removal if you have one | Yes | For coil removal |
| Bleeding after sex, between periods or after a year without periods | An examination and possibly a scan | Partly | Soon, for the examination |
| Sudden, severe tummy pain with a missed period | Emergency care | No | Call 112 now |
Not sure whether you still need contraception? A doctor can tell you in one consultation.
See available times →Contraception in perimenopause: practical steps and options
What you can do yourself
- Keep a record of your periods, so you know the date of your last natural one.
- Do not stop contraception just because your periods have become irregular.
- Keep a note of when your coil or implant was fitted and which type it is.
- Use condoms with a new partner, because sexually transmitted infections can happen at any age.
- Take a pregnancy test if a period is late or your bleeding changes suddenly.
Prescription treatment
A prescription is never issued without a consultation. The doctor may prescribe a progestogen-only pill, a combined method if it is still suitable, or emergency contraception, explain how your contraception fits with HRT, and tell you where a coil or implant can be fitted. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Treating irregular periods as a sign that you cannot get pregnant. Relying on HRT as contraception. A single hormone blood test during perimenopause. Fertility awareness, which becomes unreliable as your cycle changes.
Special situations
Periods stopping before 40
See a doctor if your periods stop before 40. It can be early menopause, and pregnancy is still sometimes possible, so ask about contraception as well as treatment.
Smoking, high blood pressure or a past clot
Combined methods are usually avoided, but progestogen-only methods and the copper coil remain options. See non-hormonal contraception for the hormone-free choices.
Thinking about sterilisation
Sterilisation does not stop your periods or ease menopause symptoms, and long-acting methods such as the coils and the implant are as effective. A partner’s vasectomy is simpler and safer than female sterilisation.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When contraception in perimenopause is handled online, and when you need in-person care
Handled online: reviewing your method, switching at 50, contraception with HRT, when to stop, emergency contraception advice, and side effects.
In-person care: fitting, changing or removing a coil or implant, the injection, blood pressure checks if you have no monitor at home, and examinations or scans for unusual bleeding.
When to get in-person care
Call 112 or go to an emergency department now for:
- sudden, severe pain low in your tummy, especially with a missed period, a positive pregnancy test or vaginal bleeding
- chest pain, sudden breathlessness or coughing up blood, especially while using a combined method
- sudden weakness or numbness on one side, a drooping face or difficulty speaking
Get medical advice the same day for:
- unprotected sex or a contraception mistake, for emergency contraception
- a painful, swollen calf while using a combined method
- a first migraine with aura, such as flashing lights or zigzag lines, while using a combined method
- a positive pregnancy test with a coil in place
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about contraception in perimenopause: say how old you are, what you use now, how your periods have changed, and whether you use HRT.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure whether a symptom comes from perimenopause or your contraception? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Menopause can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about contraception in perimenopause
Can you get pregnant during perimenopause?
Yes. You can still ovulate until the menopause. Over a year of unprotected sex, about 10 to 20 in 100 women aged 40 to 44 become pregnant, and about 12 in 100 aged 45 to 49.
Is it dangerous to get pregnant during perimenopause?
The risks of a pregnancy in perimenopause are higher than at younger ages: miscarriage affects more than half of pregnancies over 45, ectopic pregnancy is more likely, and complications for mother and baby are more common.
Can I get pregnant at 45?
Yes. Fertility is lower, but about 12 in 100 women aged 45 to 49 become pregnant over a year of unprotected sex, so contraception is still needed until you meet the stop rules.
Do I still need contraception if my periods are irregular?
Yes. Irregular periods do not mean you have stopped ovulating. Without hormonal contraception, you need it until 2 years without a period if you are under 50, or 1 year if you are 50 or over.
When can I stop using contraception?
Without hormonal contraception: after 2 years with no periods under 50, or 1 year at 50 or over. Everyone can stop at 55. If you use a hormonal method, a doctor can work out your plan.
Is HRT a contraceptive?
No. HRT uses similar hormones, but not at levels that stop you getting pregnant. If you might still be fertile, you need contraception as well.
Which contraception can I use with HRT?
With HRT you can use progestogen-only methods, the copper coil and condoms. A larger hormonal coil can also be the progestogen part of HRT, protecting the womb lining and preventing pregnancy at the same time.
What can I do at home about perimenopause symptoms while on contraception?
Keep a diary of bleeding and flushes, which helps the doctor judge whether your method still suits you; stay active and keep your weight steady, which eases flushes and protects your bones; cut down on alcohol, caffeine and smoking, which make flushes worse; and keep calcium and vitamin D in your diet. If periods are heavy or flushes are troublesome, ask about a hormonal coil, a combined method taken without a break if it is safe for you, or HRT alongside your contraception.
What is the best contraception for women over 40?
For contraception over 40, it depends on your health and periods. Long-acting methods suit many people: the hormonal coil also eases heavy periods, and the copper coil avoids hormones. Combined methods can be used until 50 if your health allows.
Can I stay on the combined pill after 40?
Often, yes: in perimenopause the combined pill can be continued until 50 if you do not smoke and have no other health reasons to avoid it, such as high blood pressure or migraine with aura. After 50, a progestogen-only or non-hormonal method is advised.
How do I know if I am in menopause while on hormonal contraception?
Usually you cannot tell, because hormonal contraception changes your bleeding. Over 50, the doctor may suggest a switch or, with some progestogen-only methods, a blood test. At 55 everyone can stop.
Can contraception hide the signs of perimenopause?
Yes. Hormonal contraception can mask perimenopause: combined methods give you a regular withdrawal bleed, the hormonal coil, implant and injection often stop periods, and combined methods can also blunt hot flushes, so you cannot tell from your periods alone where you are. That is why, on these methods, contraception is simply continued until 50 or 55 depending on the method, and why a blood test over 50 can sometimes show that you can stop earlier.
Can my coil stay in until the menopause?
A copper coil fitted at 40 or over can usually stay in until the menopause. Some hormonal coils fitted at 45 or over can stay in until 55 for contraception.
Can an online doctor help with contraception in perimenopause?
Yes. A doctor can review your method, plan contraception around HRT, prescribe a pill where suitable and tell you when you can stop. Coil and implant fittings are in person.
- FSRH Clinical Guideline: Contraception for Women Aged over 40 Years, Faculty of Sexual and Reproductive Healthcare (now the College of Sexual and Reproductive Healthcare), August 2017, amended September 2019 and July 2023.
- When can contraception be stopped? Does HRT prevent pregnancy?, Contraception Choices, College of Sexual and Reproductive Healthcare (UK), frequently asked questions, accessed 15 October 2026.
- FSRH Clinical Guideline: Intrauterine Contraception, Faculty of Sexual and Reproductive Healthcare (now the College of Sexual and Reproductive Healthcare), March 2023, amended July 2023.
- FSRH Guideline: Combined Hormonal Contraception, Faculty of Sexual and Reproductive Healthcare (now the College of Sexual and Reproductive Healthcare), January 2019, amended October 2023.
- FSRH Clinical Guideline: Progestogen-only Injectable Contraception, Faculty of Sexual and Reproductive Healthcare (now the College of Sexual and Reproductive Healthcare), December 2014, amended July 2023.
- Ectopic pregnancy, NHS, National Health Service (UK), reviewed 23 August 2022.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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