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Contraception - Management
How long should contraception be continued at the menopause?

  • The copper intrauterine device (IUD) and the levonorgestrel-releasing intrauterine system (IUS) can be retained longer during the perimenopause.
    • Women who have an IUD inserted at age 40 years or older may retain the device until they no longer require contraception.
    • Women who have an IUS inserted at age 45 years or older may retain the device until they no longer require contraception.
  • Stopping non-hormonal contraception (copper intrauterine device, condoms) at the menopause
    • Women less than 50 years of age should continue contraception for 2 years after the last period.
    • Women aged 50 years or more should continue contraception for 1 year after the last period.
  • Stopping hormonal contraception at the menopause
    • Menstrual bleeding patterns are unhelpful in determining menopause when a woman is using hormonal contraception. Amenorrhoea may be due to contraceptive hormones (progestogen-only pills, progestogen-only injectables and implants, or the levonorgestrel-releasing IUS). Regular bleeding may be due to use of combined oral contraceptives.
    • Combined hormonal contraception (pill, patch or vaginal ring) or a progestogen-only injectable
      • Switch to another suitable contraceptive method at 50 years of age (amenorrhoea may not indicate the menopause).
      • Condoms or another method should be used for 2 years after stopping progestogen-only injectables (return of ovulation can be delayed).
      • The follicle-stimulating hormone (FSH) level is not a reliable indicator of ovarian failure in women using combined hormones, even if measured during the hormone-free interval.
    • Progestogen-only pills, progestogen-only implants, or levonorgestrel-releasing IUS
      • Continue use to age 55 years, when natural loss of fertility can be assumed for most women (96%), or
      • For women over the age of 50 years who are amenorrhoeic, check FSH on two occasions, with an interval of 6 weeks between tests. If both levels are more than 30 IU/L, this is highly suggestive of ovarian failure, and contraception may be stopped after 1 more year.

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