Sure, it’s harder to get pregnant in your 40s. But if you’ve hit that magic number and figure you don’t need to worry about birth control anymore, think again.
You may have a gray hair (or two, or three), but any woman who has not experienced menopause—a full 12 months of no periods—and doesn’t have other conflicting health concerns can still theoretically get pregnant, says Camilla Bicknell, registered nurse practitioner and co-author of The Pregnancy Power Workbook.
If you’re not sure whether you’re finished having kids or not, the same birth control methods available to women in their 20s and 30s may also be good options, too. In the past, many gynecologists steered women away from the birth control pill after age 35, but that’s no longer the case.
Women’s health nurse practitioner Jacki Witt, a member of the board of directors of the National Association of Nurse Practitioners in Women’s Health, explains that your 35th or 40th birthday doesn’t magically make a hormonal birth control method less desirable. For many women, it’s a perfectly good—and safe—choice. But if you smoke and you’re in that age range, you shouldn’t be using a combination birth control pill—or anything with estrogen in it, she says. If you have high blood pressure or a history of cardiovascular disease, you may also want to opt for something else, notes the National Women’s Health Resource Center.
If, after one or two decades of having to remember to take a pill daily, you’re looking for something with a little less maintenance, there are other good hormonal methods. You could try the patch, the vaginal ring or the injection Depo-Provera. But beware that Depo causes many women to temporarily lose bone density—a side effect that typically rights itself once you discontinue use—so you may need to take extra calcium and vitamin D supplements while you’re on it.
Many physicians and women’s health nurse practitioners recommend an IUD—not only reliable, but a cost-effective choice if you’re looking for long-term birth control. You can choose from the five-year Mirena or just-approved three-year Skyla, or opt for a non-hormonal IUD like Paragard. Also, you could choose a method like the implant (Implanon or Nexplanon), which is good for three years.
You could also opt for a barrier method like a diaphragm or cervical cap, but the National Women’s Health Resource Center notes that they are less effective and less popular among women over 35.
If you’re 40 and very confident that you don’t want to have another baby, Bicknell advises that you choose a permanent contraceptive method, such as sterilization for you or a vasectomy for your partner.
If you choose the sterilization route, you can go with the traditional tubal ligation, a surgical procedure that is now frequently done as outpatient surgery or in combination with a C-section. Or you could choose a newer method of fallopian tube occlusion, like Essure, which is a set of flexible inserts that are put into the fallopian tubes. Scar tissue forms around these inserts and blocks the tube. This non-surgical procedure can be done in your doctor’s office, but you must continue to use another form of reliable birth control for at least three months.
Still undecided? The best thing to do is consult with your health care provider, who can give you additional guidance on which method to choose.