Contraception during perimenopause & menopause

Welcome to the podcast. Contraception during perimenopause & menopause this podcast is talking about a stage of life that many women enter with questions, confusion, and often very little clear guidance — perimenopause and menopause.

For many, this transition can bring a combination of changing hormones, unpredictable cycles, heavy menstrual bleeding, mood changes, sleep disruption, hot flushes, brain fog, and shifting energy levels. At the same time, contraception can still be an important consideration. One of the biggest misconceptions is that fertility disappears overnight — but pregnancy is still possible during perimenopause, even when periods become irregular.

In this episode, we’ll explore how contraception choices can support not only pregnancy prevention, but also symptom management and quality of life during the menopause transition. We’ll discuss the different options available, including hormonal and non-hormonal methods, and how individual health needs, lifestyle, and symptoms all play a role in finding the right approach.

We’ll also focus on two combined oral contraceptive pills that are increasingly discussed in this space: Zoely and Qlaira. Both can be particularly helpful for women experiencing heavy menstrual bleeding, troublesome perimenopausal symptoms, and the need for reliable contraception.

Qlaira contains estradiol valerate, a form of estrogen closer to the body’s natural estrogen, and is licensed for the treatment of heavy menstrual bleeding in women who also want contraception. It may help regulate cycles, reduce bleeding, and improve some hormone-related symptoms during perimenopause.

Zoely combines nomegestrol acetate with natural estradiol and may offer good cycle control with stable hormone levels, which some women find beneficial for mood changes, headaches, and fluctuating perimenopausal symptoms, while still providing effective contraception.

As always, there’s no one-size-fits-all solution. The best choice depends on age, medical history, migraine history, smoking status, cardiovascular risk factors, bleeding patterns, and personal preferences.

So whether you’re navigating changing periods, considering contraception in your 40s or 50s, or simply trying to understand your options during perimenopause and menopause, this episode is here to help you make informed, confident decisions about your health.

https://calmmenopause.co.uk/

https://l.instagram.com/?u=https%3A%2F%2Fwww.facebook.com%2Fshare%2F1CzLZjxgPA%2F%3Fmibextid%3DwwXIfr&e=AT05ML4wHgdNu244GlOIripK8SgnACBVq3N-pbK88PgHf52KJQDwwtDQCAys5NNNb5kTKOa7HVVAQi1KaKvJTfixUbLLm8u15OAyA0GYTNNpt9WZkyFfM7o

Transcript

SPEAKER_00 0:00

Today we are diving into a really important topic that often gets overlooked, and that is contraception during the perimenopause and menopause, addressing the question of when to stop taking contraception. Welcome to Menopause Nurse Memos, Empowering Midlife One Memo at a Time, the podcast where we tackle perimenopause and menopause topics head on with honesty, empathy, and a whole lot of heart. I'm Vicki Ellison, a nurse for 33 years and an menopause specialist nurse practitioner, an independent prescriber and founder of CAM Menopause and Wellbeing Clinic based in Appleybridge. You may be thinking, why on earth do I need contraception at this stage of my life? After all, cycles are becoming irregular, sometimes months apart, and many women assume their fertility days are long gone. But the truth is, contraception is still very important in these years. Not just for preventing an unplanned pregnancy, but also for helping manage many of the changes and challenges that come with perimenopause. I'll also be talking in more detail about two contraceptive pills, Zole and Clara, that can be particularly useful for women during the perimenopause. So why does contraception matter in perimenopause? Well, when women enter perimenopause, their ovaries are starting to slow down, but they don't stop overnight. Ovulation still happens, sometimes more unpredictably than before. This means pregnancy is still possible, and although fertility does decline quite sharply after the age of 40, it doesn't vanish completely until menopause. And menopause is officially diagnosed after 12 months with no periods at all. So whilst periods are coming and going over this period, it can be hard to truly know when contraception is no longer required. One thing to highlight is that although menopause is diagnosed 12 months after the last period, if this occurs under the age of 50, then it is recommended a woman needs to be two years without a period before she can be confident that contraception is not required, and one year over the age of 50. Now here's the thing: pregnancy during the mid to late 40s is higher risk. There are increased chances of complications such as high blood pressure, gestational diabetes, miscarriage, and chromosomal abnormalities. So preventing unplanned pregnancies is key for many women at this time in their lives. Meaning contraception still matters and it is important that women understand and know how and when to take it. But it's not just about preventing pregnancy. For many women, contraception can also play a huge role in improving quality of life during perimenopause. This is because hormonal changes can bring along heavy bleeding, unpredictable cycles, night sweats, mood swings, and even skin changes. Some contraceptive options can help smooth out these symptoms. So as a nurse, when I talk to women in their 40s and 50s, I always make a point of reminding them you may still need contraception, but we can also choose options that give you extra benefits too, for example, stopping or controlling periods and improving mood. There are hormonal and non-hormonal contraception options, and looking at the choices available. Contraception in this stage of life can include barrier methods like condoms, whether it be male or female condoms. The copper coil, which is a hormone-free intrauterine device or IUD for short, fitted by a qualified healthcare professional. One of the biggest side effects to copper IUDs is that they can make natural periods slightly longer and heavier than they are normally. The hormonal IUD, which releases levinogester progesterone and can help reduce bleeding, and again, this needs insertion and removal by a qualified healthcare professional. The implant can have potential side effects of irregular erratic periods, which can be quite an inconvenience. However, seeking advice can provide options to try to reduce erratic periods. The progesterone injection is given every 12 weeks and quite often stops periods. However, this is generally not recommended in women over the age of 50 years old as there is an increased risk of reducing bone density. So alternative methods of contraception should be sought after at the age of 50 for women on the progesterone injection. The progesterone only pill is taken every day, ideally at the same time, but some pills will have a 12-hour window to remember to take them, and some will only have a three-hour window. And of course the combined oral contraceptive pill, which contains both estrogen and progesterone. However, this is contraindicated in women over the age of 50, or anyone who suffers with migraines with aura, or if they have a BMI over 30, or if they are age 35 and over and a smoker. This is because there is a higher risk of blood clot and stroke, so alternative contraception options should be started. The combined pill is often overlooked once women reach their forties, but in fact, for many women who are medically eligible, therefore without the mentioned contraindications, it can be an excellent choice. Why is this, you may ask? Well, because it not only provides reliable contraception, but it also regulates periods, reduces heavy bleeding, helps with acne, reduces premenstrual syndrome symptoms, and even protects bone density, which is especially important as estrogen levels start to decline. And there are now two specific pills, Zole and Clara. These pills have been designed with more natural forms of estrogen known as estradiol, which is the same estrogen used in body identical HRT. Other forms of combined oral contraception have synthetic estrogen. Estradiol makes these pills better tolerated and can often be used during perimenopause as they provide women with the contraception they require as well as improving perimenopausal symptoms. So let's start with zole. Zole is a newer combined pill. It contains estradiol, which is the same type of estrogen our bodies produce naturally, along with nominogesterol acetate, which is a progestrogen. Why is this interesting? Well, most traditionally pills use a synthetic estrogen called ethanol estradiol, which is effective but not identical to the body's own hormones. Zole uses estradiol, which can sometimes feel a little more natural for the body. From a nurse's perspective, some of the benefits I've seen with Zole include more stable bleeding patterns, relief from regular or heavy periods, and skin improvements for some women, and of course, highly effective contraception. For women in their 40s, Zoli can be appealing because it offers both cyclical control and symptom relief, all while giving reliable contraceptive protection. Of course, like all combine pills, Zoli isn't suitable for everyone. Women who smoke over the age of 35 or who have high blood pressure, a history of blood clots or certain migraines may need to consider alternatives, but for the right woman it can be an excellent option. Now let's move on to Clara. Clara is another combined pill that also uses a more natural type of estrogen, estradiolvalorate, which is converted into estradiol in the body. The progesterone in Clara is dinagest. What makes Clara different is its dynamic dosing schedule. The hormone levels change throughout the cycle, which more closely mimics the natural menstrual cycle. One of the biggest strengths of Clara is that it is actually licensed not only as contraception but also as a treatment for heavy menstrual bleeding. So for women in their forties who are struggling with really heavy draining periods, Clara can be a game changer. It can reduce the amount of bleeding, improve iron levels, and make day-to-day life much easier. And like Zoli, it also provides contraception and can smooth out some perimenopausal symptoms like mood swings and hot flushes. From a nursing perspective, Clara is one of those pills that can tick multiple boxes. It's not just contraception but also a therapeutic option. Of course, whenever we talk about the combine pill, whether it is Zole, Clara or any other brand, we have to think about safety. As mentioned before, the combine pill is not suitable for everyone. If a woman smokes and is over 35, if she has uncontrolled high blood pressure, a history of blood clots or certain types of migraine, the risks may outweigh the benefits. That's why part of my role as a nurse to assess medical history carefully, check blood pressure, talk about lifestyle factors, and make sure that the chosen method is safe. And if combined pills aren't suitable, there are still lots of other options: the progestrogen-only pill, hormonal IUDs, implants or non-hormonal methods. For many women, on progestrogen-only contraception, whether it is pills, implant, depoprovera injections or leviningestral intrauterine device, they may no longer have periods, so it can be difficult to know if they are perimenopausal or menopausal without the changes in periods occurring, as they may not have had a period for a very long time. With these women, it is their symptoms of menopause that must be treated. Hormone replacement therapy can be started alongside contraception, and it is recommended that these women stay on contraception until the age of 55. If women want to know when they can finally stop using contraception, the guidance says that if you are under 50, you should continue contraception until you've had two years with no periods. If you are over 50, it's safe to stop after one year without periods. But here's the tricky part. If you are on hormonal contraception, you might still get withdrawal bleeds, which makes it hard to know when menopause has truly happened. In those cases, sometimes we'll do a blood test known as follicle stimulating hormone levels. However, even if these suggest a woman is menopausal, it is still recommended that extra protection such as condoms be used for a further 12 months, which is not what all women want to do. In those cases, sometimes we'll do blood tests known as follicle stimulating hormone levels. However, even if these do suggest a woman is menopausal, it is still recommended that extra protection such as condoms be used for a 12-month period, which not all women want or are prepared to do, which is why women are advised to stay on contraception until the age of 55 years old. The levanylgester IUD is a small T-shaped device inserted into the uterus. It slowly releases a synthetic form of the hormone progesterone called levanylgestrel. Depending on the brand, it can last 3, 5 or even up to 8 years. However, it is only the 20 microgram device that is licensed for the protection of the endrometrium alongside oestrogen for HRT. The eight-year licence is for contraception and heavy menstrual bleeding, and the three-year license is for a lower dose of levinylgestral, so not enough to protect the endrometrium. If a levinylgestral IUD is being used for HRT, then it is only licensed for five years, so will need replacing at five years whilst the woman is on oestrogen. The mechanism of action of a levanogesteral IUD is to thicken cervical mucus to block sperm, to thin the lining of the womb, sometimes it suppresses ovulation, though this isn't its main mechanism. Globally, tens of millions of women use them. They're one of the most effective forms of contraception with failure rates of less than 1% per year. As a contraceptive, the levenolgestral IUD is one of the most reliable options available. Once inserted, you don't have to remember daily pills or three-monthly injections. It is a long-acting and reversible method of contraception and a low maintenance. However, its side effects include irregular bleeding in the first three to six months, lighter periods with some women having no periods at all, hormonal side effects like mood changes, breast tenderness, acne, though usually mild, because hormone exposure is mostly local to the uterus. Up to one in three women will experience heavy menstrual bleeding at some point in their lives, particularly during perimenopause. This can cause anemia, fatigue, and major disruptions to daily life. The levinal gestural IUD works by thinning the lining of the womb, which means less tissue to shed each month. Clinical studies show it can reduce blood loss by up to 80-90% after six months of use. Many patients end up with no periods at all, which for someone with debilitating bleeding can be life-changing. So when women use estrogen for menopause symptoms like hot flushes, they need protection for the uterus, otherwise, unopposed estrogen can introduce a risk of endometrial cancer. And the levinyl gestural IUD's role provides the progesterone component of HRT. It protects the endometrium while the patient uses systemic estrogen such as gels, sprays or patches. The IUD delivers progesterone directly to the uterus, minimising systemic side effects. It also helps control bleeding during perimenopause. Simplifies treatment, one device covers contraception and endometrial protection. The potential risks of a levinal gestral IUD are rare, but there is a risk of expulsion or perforation during insertion or at a later date. There can be a risk of infection in the first 20 days post-insertion. They don't protect against sexually transmitted infections. So there you have it, the levenolgestral IUD isn't just contraception, it's a multi-tool in women's health, from preventing pregnancy to treating heavy periods to protecting the uterus during hormone replacement therapy. It's a device with wide-ranging benefits. If you're considering having a levenyl gestural IUD fitted, then talk to your healthcare provider about whether it's the right fit for your body and your goals. Remember, no single option works for everyone, but having choices is what matters. As we wrap up today's episode, I want to leave you with this thought. Contraception in perimenopause and menopause isn't just about preventing pregnancy, it's also about improving well-being. Zole and Clara are two examples of modern contraceptive pills that can not only provide reliable protection but also help manage heavy bleeding, irregular cycles, and other perimenopausal symptoms. As a nurse, my role is to support women through this stage of life, making sure they feel informed, heard, and empowered in their choices. Thank you so much for joining me on today's episode of Menopause Nurse Memos. I hope this has helped you shine a light on the importance of contraception in the perimenopausal years. Take care of yourselves and remember you deserve the right information to make confident, empowered decisions about your health. Next time on the podcast, we will be talking about the benefits of HRT. Thank you for spending time with me today on Menopause Nurse Memos. If this episode resonates with you or you know someone who needs to hear it, then share and leave your comments in the chat. And don't forget to subscribe so you never miss an episode. Until the next time, take care of yourselves. You are worth it.