When contraception can be stopped

If not using hormonal contraception then:

• if under 50 years - after two years amenorrhoea (1,2)
• if over 50 years
  • if using barrier methods then continue until one year after amenorrhoea
  • if using intrauterine contraceptive device > 300 mm^2 copper
    • remove IUCD after one year of amenorrhoea if the last menstrual period at or after the age of 50 years

If using contraception:

• if using COC - can be prescribed in low-risk women until aged 50 years
  • at aged 50 years switch to an alternative method of contraception (progestogen only pill or barrier). Subsequently follow advice on stopping contraception as per method used
    
    
• progestogen only pill, implants or intrauterine system - amenorrhoea does not indicate that the menopause has occurred
  • if aged 50 years then some advise contraception (progestogen only pill, implant or intrauterine system) to be continued until the age of 55 years when the natural loss of fertility can be assumed (96%) (1)
  • women using exogenous hormones should be advised that amenorrhoea is not a reliable indicator of ovarian failure
    • in women using contraceptive hormones, follicle-stimulating hormone (FSH) levels may be used to help diagnose the menopause, but should be restricted to women over the age of 50 years and to those using progestogen-only methods
      • FSH is not a reliable indicator of ovarian failure in women using combined hormones, even if measured during the hormone-free interval
      • if at 50 years old the woman wished to stop her contraception then
        • continue with the contraceptive method
        • measure FSH on two occasions at least 6 weeks apart
        • if both FSH levels are > 30 IU/l then this is highly suggestive of ovarian failure and methods may be stoped after one further year
        • note that if the levenorgestrel intrauterine system is inserted at or after the age of 45 years then it may be retained for seven years' use if the bleeding pattern is acceptable, if using it for contraception, but not if using it as the progestogenic component of HRT; however seven years' use is outside the product licence (2,3)
          
          
• injectable progestogens - amenorrhoea does not mean that the menopause has occurred
  • at the age of 50 years then switch to an alternative method (progestogen only pill or barrier). Subsequently follow advice as to stopping contraception as described for particular contraceptive method

Women using non-hormonal methods of contraception (3)

• women using non-hormonal methods of contraception can be advised to stop contraception after 1 year of amenorrhoea if aged over 50 years, 2 years if the woman is aged under 50 years
• after counselling (about declining fertility, risks associated with insertion, and contraceptive efficacy), women who have a Cu-IUD containing >=300 mm2 copper, inserted at or over the age of 40 years, can retain the device until the menopause or until contraception is no longer required
• women who continue to use their IUD until contraception is no longer required should be advised to return to have the device removed

Reference:

1. Prescribers' Journal 2000;40 (2):121-129.
2. Pulse September 17th 2005: 62-4
3. FSRH (2010). Contraception for Women Aged Over 40 Years