ADVICE: Do I need birth control if I have hot flashes?

Even though fertility declines as a woman approaches menopause, pregnancy is still possible.

Maja Begovic 4 minute read December 11, 2020
Menopause hot flashes

Dear Asking For a Friend,

I have been having night sweats and irregular periods for months. Is this the start of menopause? And is there still a chance I could get pregnant? 

Signed, Hot Flashes

Dear Hot Flashes,

You’re in a transitional time of your life, but just because you’re experiencing night sweats and irregular periods, it doesn’t mean you’ve reached menopause — at least not yet. Research shows that the average age for menopause is 51, but symptoms can start a few months or several years before your last period.

The years leading up to menopause are clinically referred to as perimenopause — it’s a time when symptoms such as vaginal dryness, night sweats, irregular periods and hot flashes first appear. At this stage, hormone levels begin to taper off, your period may vary in length and frequency, and your ovaries may or may not release eggs each month. Perimenopause can drag on for more than a decade for some women, and while your fertility starts to decline at this stage, you can still get pregnant.

In perimenopause, it’s not unusual for your period to stop and restart again after a few months. Only when you’ve been period-free for a full year do your hormone levels change, you no longer ovulate, and your chances of getting pregnant decline.

“Once in menopause, it is no longer possible to get pregnant,” says Dr. Jennifer Blake, chief executive officer at The Society of Obstetricians and Gynaecologists of Canada (SOGC). “During the years leading up to the menopause, it is certainly possible; fertility declines, but unexpected pregnancies do happen.”

Blake says that during perimenopause, it’s important to continue to use appropriate means of birth control. She suggests that women speak with a healthcare provide to assist them in choosing a birth control method that is safe and effective, taking into account age and other medical considerations. The SOGC’s online platform has information on contraceptive methods that are available and approved for use in Canada, and can help women make family planning and birth control decisions at any age.

Only when you’ve been period-free for a full year do your hormone levels change, you no longer ovulate, and your chances of getting pregnant decline

Hormonal oral contraceptives, sterilization, barrier methods, such as diaphragm or spermicide, and non-oral contraceptives that include injections, skin patches or vaginal rings, are just some of the options available to women in Canada. The morning after pill can also be used 72 hours after intercourse, but should not be treated as an option for regular form of birth control.

If you do become pregnant in perimenopause, Blake says that “women who are in good health going into pregnancy at older ages can still have healthy pregnancies, but there are some risks to be aware of.”

Increased risk of miscarriage, chromosomal abnormalities, such as Down syndrome, and multiple pregnancies are some of the biggest concerns, according to Blake. Older women may also face medical complications, such as gestational diabetes or high blood pressure. The likelihood of needing a caesarean section increases with age, according to Blake, as does having a baby that is born prematurely. “For these reasons, it is better to plan a pregnancy than be surprised by one, particularly in older age groups,” she says.

Unplanned pregnancies can happen in perimenopause, so if you’re trying to avoid getting pregnant at midlife, speak to your healthcare provider about a contraception option that is right for you.

Maja Begovic is a writer with

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