Can I use contraception and menopausal hormone therapy at the same time?

Yes, in some circumstances. Menopausal hormone therapy is not contraceptive. Women under 55 who are still potentially fertile — even with irregular or absent periods — still need contraception unless post-menopausal status is confirmed (12 months without menstruation). The June 2026 eTG update provides explicit guidance on which contraceptives can be combined with cyclical MHT. Your GP can review your individual situation.

eTG June 2026: new contraceptive options and guidance for women over 50

Q: What is Slinda and how is it different from other progestogen-only pills?

Slinda (drospirenone 4mg) is a progestogen-only pill that works primarily by suppressing ovulation — unlike traditional progestogen-only pills (norethisterone, levonorgestrel) which mainly thicken cervical mucus and require a strict 3-hour dosing window. Slinda has a 24-hour missed-pill window and may suit women who need a progestogen-only option without oestrogen. The June 2026 eTG update includes it in Australian clinical guidance for the first time.

What just happened

Therapeutic Guidelines has announced the release of its June 2026 update to the Sexual and Reproductive Health guidelines — the first Australian clinical guidance to incorporate two recently available contraceptive pill options into practice recommendations.

Slinda (drospirenone 4mg) is a progestogen-only pill. Unlike traditional progestogen-only pills — norethisterone (Noriday) or levonorgestrel (Microlut) — which primarily work by thickening cervical mucus and require a strict 3-hour dosing window, Slinda works mainly by suppressing ovulation. This gives it a 24-hour missed-pill window, substantially more forgiving in practice. For women who need or prefer a progestogen-only option — because oestrogen is contraindicated (history of venous thromboembolism, migraine with aura, certain liver conditions), or because oestrogen-containing pills are poorly tolerated — Slinda represents a genuinely different option on the Australian formulary.

NextStellis (estetrol 15mg + drospirenone 3mg) is a combined oral contraceptive pill containing estetrol — a natural oestrogen produced by the foetal liver during pregnancy. Estetrol has a distinct receptor binding profile from ethinyl oestradiol (the oestrogen in most combined pills): it has weaker hepatic effects and a more selective tissue action profile that may differ in its impact on clotting factors and metabolic parameters. The TGA approved NextStellis in 2025. The June 2026 eTG update represents its formal entry into Australian prescribing guidance.

The update also specifically addresses a question that comes up frequently in general practice: what do women aged 50 and over do about contraception when they are also using menopausal hormone therapy? The June 2026 eTG release now provides explicit guidance on which contraceptives can be combined with cyclical combined menopausal hormone therapy — filling a gap that has historically required either specialist referral or clinical judgment under uncertainty.

Additional changes in the June 2026 update: rufinamide has been added to the list of antiepileptic drugs that interact with hormonal contraceptives; expanded advice on lamotrigine’s interactions with hormonal contraception; and vaping is now included in the section on tobacco smoking and eligibility to use hormonal contraception.

The both-and

Contraception in the perimenopause is both a reproductive health question and a hormonal health question. The clinical system often addresses one or the other. Holding both simultaneously is the challenge — and the June 2026 eTG update begins to do that.

The question of when a woman can stop contraception is one of the most commonly asked — and most inconsistently answered — questions in general practice during the menopause transition. The short answer: menopause is only confirmed retrospectively, after 12 consecutive months without menstruation. Until that is established, the risk of pregnancy, though declining with age, is not zero. Women under 55 who are still potentially fertile generally need contraception even with irregular or absent periods. This remains true whether or not they are also using menopausal hormone therapy for symptom management.

Menopausal hormone therapy is not contraceptive. This is routinely misunderstood, and it matters. The oestrogen and progestogen in MHT are prescribed at doses designed to relieve menopausal symptoms and protect bone density — not to suppress ovulation. A woman in her late 40s taking MHT who still has ovarian function could, in principle, ovulate. The Australasian Menopause Society has emphasised this consistently. The June 2026 eTG update now provides explicit clinical guidance on which contraceptive formulations can run alongside cyclical MHT — reducing the uncertainty and the barrier to GP-led decision-making.

The two newly included pill options address meaningfully different patient profiles. Slinda’s progestogen-only mechanism matters for women for whom oestrogen is contraindicated — venous thromboembolism history, active migraine with aura, certain liver conditions — who still require reliable contraception through the perimenopause years. NextStellis, with its estetrol-based oestrogen component, may offer an alternative profile for women experiencing side effects on older combined pill formulations, though head-to-head evidence against standard preparations is still limited.

The update on vaping and hormonal contraceptive eligibility also carries practical weight. Tobacco smoking is a contraindication to combined oestrogen-progestogen contraception in women over 35 — a risk mediated by oestrogen’s thrombotic and cardiovascular effects, amplified by the vascular damage from tobacco. Whether vaping carries an equivalent risk has been a clinical grey zone. The June 2026 eTG update begins to address this, even if the evidence base on vaping-specific vascular risk remains sparser than for tobacco.

2 cents

If you are in your 40s, using MHT, and uncertain whether you still need contraception: the answer, unless your GP has confirmed you are post-menopausal, is probably yes. This update makes it easier for your GP to identify which contraceptive formulation works alongside your current MHT without guesswork.

If you are on an older progestogen-only pill and managing the 3-hour dosing window as a daily stressor: ask your GP whether Slinda is available and appropriate for your situation.

If you take antiepileptic medicines — rufinamide, lamotrigine, or enzyme-inducing antiepileptics like carbamazepine — and use hormonal contraception: this updated eTG guidance is worth raising with the GP or specialist managing your epilepsy, since some antiepileptic interactions can reduce contraceptive reliability significantly.

This is general information. Contraceptive choices require individual assessment with your GP. PBS listing status for specific products changes; your GP can confirm current availability and subsidy.

Verdict

Verdict: yes — worth knowing about.

The June 2026 eTG Sexual and Reproductive Health update brings two new contraceptive pill options into Australian clinical guidance and provides explicit guidance for women over 50 combining contraception with menopausal hormone therapy. For women managing contraception and menopausal symptoms simultaneously — a situation that is more common than the system has historically made room for — this update is reason to revisit that conversation with your GP.