KEY INSIGHTS

Contraception to prevent unplanned pregnancy should be maintained into menopause for a full 12 months after the last menstrual period if this occurs after the age of 50, and for 24 months if it occurs before age 50.

MHT (or HRT) replaces hormones lost in menopause and can optimise a woman’s wellbeing and overall health up to the age of 60. It always includes oestrogen, and for women who have not had a hysterectomy, progestogen must be included to protect the lining of the uterus.

The Mirena® hormonal IUD is prescribed to many post-menopausal women as the progestogen part of MHT. Gynaecology Centres Australia (GCA) is a leading private women’s health clinic in NSW, offering IUD insertions using intravenous sedation for your comfort and safety.

Why Use an IUD After Menopause?

Maintaining your use of contraception to prevent unplanned pregnancy is as important later in your reproductive life as it is at any other stage, and some women remain fertile (even unexpectedly so) into their late 40s (or longer). An IUD can be a great option for women seeking a long-acting, consistent, “set-and-forget” birth control solution.

But at what point is contraception no longer required?

What about after menopause?

What role does an IUD play in hormone replacement?

What Drives Menopause Timing?

Menopause occurs when a full 12 consecutive months without a menstrual period have passed. The period of up to 10 years before menopause is the perimenopause, and this can be characterised by hormonal shifts and associated hot flashes, mood swings, heavy and/or erratic menstrual bleeding, insomnia, weight gain, vaginal dryness, headaches, pelvic pain, “brain fog”, and various other symptoms.

The average Australian woman naturally reaches menopause at age 51, with a range for the majority between age 45 and 55. The age a woman begins perimenopause, its duration, and when menopause finally occurs are influenced by:

Genetics – the age your mother entered menopause is a strong predictor for your own menopause age.
Body weight – because fat stores oestrogen, a lower BMI can correlate with a younger menopause onset age.
Smoking cigarettes – linked to earlier-onset menopause.
Some autoimmune conditions can result in ovarian failure at an early age.
Prior surgery to the ovaries and/or infections can result in premature ovarian failure.

Certain medical interventions can accelerate or even trigger immediate menopause. These include:

Hysterectomy – removal of the uterus (leaving the ovaries) immediately stops menstrual periods from occurring. The ovaries continue producing hormones, and the menopausal process otherwise continues naturally.
Oophorectomy is the surgical removal of the ovaries. When both ovaries are removed, whether the uterus remains or not, menopause occurs immediately.
Cancer treatments such as pelvic radiation therapy, chemotherapy, and some hormone-inhibiting medications (used in breast cancer treatment, for example) can damage the ovaries. This halts normal ovarian function.

How Does an IUD Affect Menopause?

Using any hormonal contraceptive, including an IUD, does not impact when a woman enters menopause. While a lot of women are prescribed a hormonal IUD during perimenopause to help make menstrual periods lighter and regulate them (or even stop them from happening altogether), the timing of natural menopause does not change.

Hormones from contraceptives may mask some menopausal symptoms. If you have an IUD in your late 40s and early 50s, it can be difficult to know whether you are in menopause or not, as it can prevent menstrual bleeding altogether. Hormonal IUDs can also cause some symptoms that resemble menopause, but other menopausal symptoms that occur due to dropping oestrogen levels will still be present. Your GP can order blood tests to check your follicle-stimulating hormone (FSH) and oestrogen levels and, alongside your symptoms, determine whether you are indeed in menopause.

How Long Do I Need Contraceptive Protection?

To prevent an unplanned pregnancy, it is recommended that you use contraception:

for a full 12 months after your last menstrual period if it occurs after the age of 50
for a full 24 months if it occurs under the age of 50.

You need to speak with your GP about continuing the use of oestrogen-based contraceptives (e.g. the combined oral contraceptive pill, contraceptive patch, vaginal ring) after the age of 45 years; these are generally not recommended for women over the age of 50 due to certain risk factors; this is of critical importance for women who smoke/vape.

The progestogen-only pill and hormonal IUDs are safer for use for women over the age of 45.

There are also compelling reasons why women in menopause should continue to use a hormonal IUD.

Why Would a Postmenopausal Woman Get an IUD?

Australian women have access to two hormonal contraceptive IUD products:

Mirena® is a T-shaped plastic intrauterine device that contains the progestogen hormone levonorgestrel. It contains a 52mg dose and is approved to remain in place for use as a contraceptive for up to 8 years. It is also used to treat painful or heavy periods. The Mirena® is also prescribed to help protect the uterus during hormone replacement therapy, in which case it is approved to remain in place for up to 5 years.
Kyleena® is a smaller T-shaped intrauterine device that delivers a much lower dose of levonorgestrel. While it provides contraception for up to 5 years, it is not licensed or approved for use as a menopausal treatment to protect the lining of the uterus during hormone replacement therapy.

Hormonal IUD as Menopause Treatment

Many women turn to menopausal hormone therapy to help deal with the physical and mental impacts of menopause. Formerly called hormone replacement therapy (HRT), menopausal hormone therapy (MHT) is prescribed to replace declining hormones during this time. This aims to help maintain bone density, heart health, metabolic health, brain health, sexual function, and improve a woman’s overall sense of wellbeing.

According to The Australian Menopause Society:

MHT is the most effective treatment available for night sweats and hot flushes.
Non-oral administration routes are gentler and safer, e.g. transdermal patches.
Used by healthy women under age 60 or within 10 years of the last menstrual period and with no risk factors (e.g. a history of breast cancer, stroke, blood clots), MHT is considered safe, and its benefits outweigh its risks.

Oestrogen is what treats the symptoms associated with menopause.

For women who still have an intact uterus (i.e. they have not undergone a hysterectomy), MHT must include progestogen. This is because oestrogen stimulates the growth and thickening of the lining of the uterus (hyperplasia), and this increases the risk of developing cancer. Using a Mirena® alongside oestrogen MHT (ideally, transdermal patches or gels) offers protection and is considered the safest delivery method for combined MHT.

For women without a uterus, progestogen is not required, and oestrogen-only MHT is recommended.

IUD Insertion at Gynaecology Centres Australia

Having an IUD inserted at any point during your reproductive life and into menopause should be a calm, comfortable experience carried out in a caring professional environment.

GCA is a leading private NSW women’s health clinic offering IUD insertions using IV sedation. We also offer surgical abortion services and vasectomies for men.

Our commitment to the comfort and wellbeing of our patients at Gynaecology Centres Australia is unwavering, and we perform all IUD insertion procedures using an intravenous sedative (“twilight” sedation). This means that, when you have an IUD inserted with us, you will be asleep for the procedure and feel no pain during the insertion. We provide the sedation medication at no extra cost (if you have a valid Medicare card).

We are here to support you and your wellbeing at every stage of your reproductive life and in menopause. To book an appointment with us for IUD insertion, contact us online or phone a conveniently located clinic:

Hurstville (Sydney) – (02) 9585 9599

Newcastle – (02) 4962 4999

Gosford – (02) 4324 5176

Wollongong – (02) 4227 4100