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Combined contraceptive pill when approaching the menopause

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Combined Hormonal Contraception in women aged over 40 years

  • may be given if no contraindications to women up to the age of 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

  • meta-analyses have found a slight increased risk of breast cancer among women using COC, but with no significant risk of breast cancer by 10 years after cessation

  • women who smoke should be advised to stop CHC at 35 as this is the age at which excess risk of mortality associated with smoking starts to become clinically significant

  • combined hormonal contraception (CHC) use in the perimenopause may help to maintain bone mineral density

  • use of CHC may help to reduce menstrual pain and bleeding

  • CHC may reduce menopausal symptoms

  • however women experiencing menopausal symptoms while using CHC may wish to try an extended regimen

  • CHC use provides a protective effect against ovarian and endometrial cancer - lasts for several decades after cessation of the method

  • cervical cancer - appears to be a small increased risk of cervical cancer associated with COC use (former or current)

  • there may be a reduction in the incidence of benign breast disease with CHC use (1)

  • there is a reduction in the risk of colorectal cancer with CHC use

  • there may be a small additional risk of breast cancer with CHC use, which reduces to no risk 10 years after stopping CHC use

  • women who are aged 35 years or over and smoke should be advised that the risks of using CHC usually outweigh the benefits

  • clinicians should be aware that there may be a very small increased risk of ischaemic stroke with CHC use

  • women with cardiovascular disease, stroke or migraine with aura should be advised against the use of CHC

  • practitioners who are prescribing CHC to women aged over 40 years may wish to consider a pill with <30 µg ethinylestradiol as a suitable first choice

  • hypertension may increase the risk of stroke and myocardial infarction (MI) in those using CHC

  • blood pressure should be checked before and at least 6 months after initiating a woman aged over 40 years on CHC and monitored at least annually thereafter


  • 1) FSRH (2010). Contraception for Women Aged Over 40 Years.
  • 2) FSRH (2019). Contraception for Women Aged Over 40 Years.

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