Contraception over 40: birth control options for women

Updated October 2022 | 4 min read
Expert contributors Dr Amanda Newman, women’s health specialist GP, Jean Hailes for Women’s Health; Dr Deborah Bateson, clinician, Family Planning NSW
Words by Karen Burge

As you get older your health risks and hormones change. If you’re a woman considering contraception over 40, you may want to review your options. Here are some of the birth control choices worth considering.

Your fertility might decline after 40 but that doesn’t mean birth control should slip off your radar. Women in their 40s can still get pregnant or experience unplanned pregnancies.

The contraceptive(s) that worked for you in your 20s and 30s might not be as appropriate now, as your risk of developing heart disease, diabetes, cancer and bone fracture increases. So, as you hit the age of 40, it’s an ideal time to rethink your birth control options.

All contraceptives have pros and cons so it’s wise to speak to your GP about what works for you. If you want more information, credible sources include Family Planning NSW and Jean Hailes for Women’s Health.

Here’s a range of options, and because it takes two, we've included contraceptive options for men too.

Contraceptive implants

Hormonal intra uterine device (IUD)

Hormones are chemical messengers that communicate and coordinate different functions in your body. Hormones can be used to affect your menstrual cycle to prevent pregnancy. There are two types of hormonal IUDs in Australia – the Mirena and the Kyleena. This small plastic device contains a very low dose of slow-releasing progestogen and is inserted by a trained doctor or nurse into the uterus to prevent pregnancy. It thickens the mucus of the cervix to stop sperm from reaching the uterus. Often periods become much lighter, or even stop, as a result.

“Most of the action is in the lining of the uterus – not much is absorbed,” explains Dr Amanda Newman, women’s health specialist GP with Jean Hailes for Women’s Health.

“If you have a Mirena inserted after the age of 45, you can leave it there for the next 10 years.” If you’re under 45, it’s recommended you change it after five years.

The hormonal IUD, and other long-acting reversible contraception (LARC) methods, provide effective contraception for extended periods. They can be good for women over the age of 40 because they don’t carry the same risks as oestrogen-containing options like the combined pill.
The Kyleena and the Mirena are a longer-term solution with an effectiveness of 99.7% to 99.9%.

Copper IUD

Another LARC, the copper IUD is also inserted inside the uterus. It’s hormone-free and has copper wire wrapped around its stem, preventing a fertilised egg from settling in the uterus. It creates an unfriendly environment for sperm.

It’s suitable for women who need to be hormone-free (like those with a history of breast cancer) or women who want a hormone-free alternative, says the medical director of Family Planning NSW, Dr Deborah Bateson.

The downside is that periods can become heavier and last longer.

Progestogen implant

A flexible rod is inserted by a trained doctor under the skin in your arm, where it continuously releases a low dose of progestogen into your blood over three years – making this another LARC. There’s one type of progesterone implant in Australia, called Implanon. Some women with this implant have no or light menstrual bleeding, and it may also reduce premenstrual syndrome.

Oral contraceptives

The pill

The combined oral contraceptive pill stops the ovaries from releasing an egg each month, preventing pregnancy. But you do have to remember to take it every day.

Research has shown that women over 35 who smoke and take the pill are at greater risk of heart attack and stroke. If you have diabetes, the pill can also increase your risk of complications.

The mini pill

The mini pill, or progestogen-only pill, contains only a low dose of progestogen and is very effective in women older than 40 as fertility naturally declines. The mini pill has to be taken at the same time every day – within a narrow timeframe of three hours.

Contraceptive surgery or permanent contraception

Tubal ligation

Some women in their 40s consider tubal ligation if they’re certain they don’t want to have any, or more, children. It’s a permanent method of contraception.

Tubal ligation involves keyhole surgery in your lower abdomen which means undergoing a general anaesthetic. Clips are put on your fallopian tubes to block sperm from reaching an ovum (egg). There are small risks associated with this procedure which your doctor can discuss with you.

Vasectomy

A vasectomy is an operation for men to cut the tubes that carry sperm from the testes. About one in four men over the age of 40 have had a vasectomy, according to Andrology Australia. If you’re considering this option, ask your GP for a referral to a specialist.

Barrier contraception

Male condoms

Condoms reduce the chance of unplanned pregnancy and the risk of contracting a sexually transmitted infection. But they’re not as effective as some other methods in preventing pregnancy – just 82 to 98% according to Family Planning NSW. Condoms can be combined with other methods of contraception, including the pill, injections, implants and IUDs.

Female condoms

Female condoms are internal condoms that are worn inside the vagina. It helps to prevent pregnancy and sexually transmitted infections (STIs). In Australia, the female condom is a thin nitrile pouch inserted into the vagina.

Need to make an appointment with a GP?

Speak to your GP about the birth control options that may be right for you. Our partnership with GP2U, an online video GP service, makes it easier for eligible members to access telehealth services. All HCF members with health cover can access a standard GP consultation (up to 10 minutes) for a fee of $50. See hcf.com.au/gp2u for more information.