Birth control during menopause

Using the Pill to Treat Menopause

While the main reason to take birth control pills is to prevent pregnancy, it turns out that the Pill can also act as a treatment for women approaching menopause — the time period called perimenopause — to manage irregular periods, hot flashes, and night sweats.

Birth control pills contain various combinations of the hormones estrogen and progesterone and are designed to shut down ovulation so that you don’t release a monthly egg and can’t get pregnant.

“As women age, the balance between the pituitary gland that excretes follicle stimulating hormone (FSH), and the ovary that excretes estrogen is all over the place,” says Robert S. Wool, MD, an ob-gyn at Noble Hospital, Mercy Medical Center, and Baystate Medical Center and in private practice in Westfield and Springfield, Mass. “Women may be making estrogen, but not usually cycling. Birth control pills will quiet the wildness of the reproductive cycle in a perimenopausal woman.”

It is important to note that, once you reach true menopause, you’ll stop taking the Pill — there’s no longer the need to suppress ovaries once they’re no longer active. If you’re still experiencing unpleasant symptoms, hormone replacement therapy, which uses smaller doses of hormones, might be an option, though you’ll want to discuss the risks with your doctor.

The Pill: Pros and Cons

Generally, birth control pills can bring relief for many perimenopausal women experiencing hot flashes or irregular periods, or both. If you and your doctor choose the birth control pill as a treatment for perimenopause, a low-dose type is best — usually 20 micrograms of ethinyl estradiol or less, but it may take some trial and error to find just the right dosage.

The Pill isn’t appropriate for every woman, however. “Women over age 35 who smoke are not good candidates to take birth control pills,” says Julia Schlam Edelman, MD, author of Menopause Matters: Your Guide to a Long and Healthy Life. “Smokers are at higher risk for getting a heart attack or stroke if they are over age 35 and take birth control pills.” Women with high blood pressure, who have had a blood clot in their leg, lung, or pelvis, who have had breast cancer, or who have liver disease also should not use birth control pills.

While the benefits of taking birth control pills may include relief of perimenopause symptoms like hot flashes and irregular cycles, there can also be the typical side effects of oral contraceptives, such as irregular bleeding (especially in the first few months), nausea, puffiness, and weight gain (though many low-dose oral contraceptive pills are weight neutral), says Charla Blacker, MD, a reproductive endocrinologist at Henry Ford Hospital in Detroit. “Mood swings usually are improved. However, occasionally, women report more depression with birth control pills. If a woman did not tolerate birth control pills during her early reproductive years, she may not tolerate them well in perimenopause.”

Also, women should be aware that birth control pills are not the fountain of youth. “Birth control pills can mask and treat symptoms,” says Dr. Wool, “but they do not alter the aging process.” Menopause will still occur when nature intends, although if a woman continues on perimenopausal birth control pills, she may not realize exactly when she has passed into menopause. In that situation, after stopping the pills, she will no longer menstruate and may begin to have hot flashes that were previously masked.

Ultimately, whether to use the Pill for perimenopause symptoms is a decision that should be made by you and your doctor. Each woman’s situation is different and there is no one-size-fits-all solution.

Menopause and Birth Control

Menopause and Birth Control: When Is It Time to Quit?

Menopause can be a distressing, confusing time for many women. It’s a natural part of life, and there is no way to know when it will start and exactly when it will end because every woman is different. So when is menopause really over, and when is it safe to quit taking birth control pills? And, can birth control pills help or worsen menopause symptoms? The following article will explore how birth control and menopause interact and when it’s safe to quit taking birth control pills to prevent pregnancy.

What is the difference between menopause and perimenopause?

Perimenopause is the beginning stages of menopause. Perimenopause is the time when women’s reproductive hormones first start to change. Women continue to have periods during perimenopause, but they start to become irregular. In contrast, menopause is the final period a woman has. If a woman has gone 12 months without a period, she has gone through menopause. Her life after that 12 months is considered postmenopausal.

When does perimenopause usually start and how long can it typically last?

Every single woman is different. But the average length of perimenopause is four years. The average age of onset for perimenopause is the mid-forties. But some women can experience perimenopausal symptoms as early as the late 30s, or as late as the early 50s. In rarer cases, perimenopause symptoms can last for up to ten years.

What are the symptoms of perimenopause?

Perimenopause can cause many different symptoms that are both disruptive, distressing, and sometimes painful. Symptoms can include the following:

  • Hot flashes and night sweats
  • Breakthrough bleeding and spotting
  • Irregular periods
  • Headaches and migraines
  • Mood swings
  • Trouble sleeping
  • Urine urgency and urine leakage
  • Vaginal dryness
  • Mood swings
  • Acne
  • Fatigue
  • Breast tenderness
  • Lower sex drive
  • Heavier, more painful periods

Sometimes, the symptoms of perimenopause can cause significant problems in day-to-day functioning. Fortunately, women can find relief from these symptoms with hormone replacement therapies and hormonal birth control.

When should a woman see her doctor about perimenopausal symptoms?

It’s common for women to have irregular periods during the perimenopausal stage. However, other more serious conditions can mimic the symptoms of perimenopause. It’s important for women to speak to their doctor to rule out more serious conditions. Hormonal issues, fibroids, pregnancy, blood clotting disorders, and even cancer can cause some of the symptoms usually associated with perimenopause. The following symptoms may warrant a trip to the doctor for testing:

  • Very heavy periods with blood clots.
  • Periods that last much longer than usual.
  • Breakthrough bleeding between periods.
  • Spotting after intercourse.
  • Periods that are happening closer together than normal.

Can women get pregnant even if they’re perimenopausal?

Despite declines in fertility during perimenopause, it’s possible to still become pregnant. To prevent pregnancy, women should continue to use birth control until they reach menopause. If preventing pregnancy is the goal, women should not stop using birth control until they have gone twelve months without a period.

How does birth control affect perimenopause symptoms and menopause?

Birth control pills can help to regulate periods and also reduce pain and bleeding. Birth control pills also help to level out hormones, keeping them from fluctuating to the point of triggering worse perimenopause symptoms. Going through menopause can also cause issues with bone health and bone density. Taking oral contraceptives while perimenopausal can decrease these risks. Once menopause happens, women can stop taking birth control pills.

Some women will find relief from the hot flashes commonly associated with perimenopause after taking low-dose birth control pills. Birth control patches, the vaginal ring, and progesterone injections can also alleviate uncomfortable symptoms.

It is important to note, however, that hormonal contraceptives can mask perimenopause symptoms. Women who’ve been taking hormonal birth control can sometimes not know when they’ve reached the perimenopause stage. Women who continue to take hormonal birth control can continue to go through monthly cycles even after they’ve reached menopause.

When should women not take birth control pills for perimenopause?

Women with a history of blood clots, either personal medical history or family medical history, should stop taking hormonal contraceptives as they enter their late forties. Women who smoke, have heart disease, or a history of cancer should also avoid taking oral contraceptives as they age. Hormonal contraceptives can increase the risk of blood clots in older women with risk factors for these disorders and in women who smoke.

Since hormonal birth control can mask the symptoms of perimenopause, sometimes it’s important to mitigate the risk of blood clots by coming off hormonal birth control regardless of whether or not a woman has experienced perimenopausal symptoms if she has these risk factors.

High-doses of estrogen in many oral contraceptives can increase the risk of blood clots. Instead of using high-dose hormonal birth control to alleviate the symptoms of perimenopause, women can try hormone therapies instead or low-dose birth control pills. To prevent pregnancy, non-hormonal birth control options can also be used during this stage of life.

Low dose birth control pills have 20 mcg of estrogen. Very low dose contain 10 mcg of estrogen. Regular birth control pills have around 30 to 50 micrograms of estrogen. For women 45-49 years old, an endocrinologist from Mt. Sinai New York recommends 20 mcg and changing to 10 mcg for those 50 and older.

How can I tell if I’ve reached menopause?

If a person is on birth control, there is no way to know for sure if they have reached menopause. Someone who is taking the pill may still have “periods” which are actually withdrawal bleeds because of the hormones in the medication.

The average age of menopause is around 51 years old. Some doctors recommend that a person stops taking the pill around this age to see if they have reached menopause yet.

However, someone stopping the pill at this age should still use contraceptive during sex until menopause is confirmed.

How can perimenopausal women benefit from low-dose estrogen birth control?

Not only can low-dose estrogen contraceptives prevent pregnancy, but they can also alleviate uncomfortable and disruptive perimenopause symptoms. In addition, low-dose estrogen pill help to regulate periods, prevent heavy periods and also protect against bone density loss. Without this protection, women are at increased risk of osteoporosis as they age. Another potential benefit of using birth control pills is the prevention of ovarian and uterine cancer.

For women going through perimenopause, they do not have to live with distressing and uncomfortable symptoms. Accessing safe, low-dose hormonal contraceptives is now easier than ever before with companies like Pandia Health. Contact Pandia Health today to have birth control conveniently delivered straight to your door.

Disclaimer:

The views expressed in this article intend to inform and induce conversation. They are the views of the author and do not necessarily represent the views of Pandia Health, and are for informational purposes only, even if and to the extent that this article features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment, and should never be relied upon for specific medical advice.

“Hot flashes, night sweats, anxiety, headaches, acne, joint pain, and a brand-new belly? Woot! BRING IT ON!” said no woman. EVER.

And yet, if we are fortunate to live long enough, many of us will endure at least some of these of these symptoms at perimenopause and menopause.

Erratic and dropping estrogen is the primary culprit behind many menopause symptoms. Before reproduction shuts down for good at around age 51, rises and dips in hormone levels are responsible for the emotional and physical roller coaster ride many women experience, starting as early as their mid-30s.

One way to manage many perimenopausal symptoms may be a treatment you thought you were done with: the Pill.*

Why pop the Pill for perimenopause?

NOTE: As Dr. Sherry told us, if you’re still having periods, erratic or otherwise, you can still get pregnant. So if you engage in intercourse with men, some sort of birth control is called for. After teens, perimenopausal women have the second highest rate of unintended pregnancies.

The Pluses: Low-dose birth control pills can help ease the perimenopause transition for many women by regulating hormones. This can reduce hot flashes, ease mood swings, lessen the menstrual flow, regulate erratic periods, and lessen the impact of endometriosis. According to Harvard Health, birth control pills may also reduce vaginal dryness and prevent bone loss, all while protecting you from endometrial and ovarian cancers and those unintended pregnancies. And, WebMD adds, low-dose birth control pills may also help stave off colorectal cancer.

Risks of low-dose birth control?

Because the amount of hormones is so low, and because current formulations of the Pill are safer than previous versions, there are fewer side effects and risks to fear. Studies show low-dose birth control doesn’t cause weight gain, and vascular issues like deep-vein thrombosis and stroke aren’t generally an issue for women over 35 who don’t smoke.

The Minuses: The risk of increased breast cancer is still a subject of some debate, particularly when it involves women who are older (possibly because they started with the riskier, higher-dose oral contraceptives that were available when they were younger) or who have a family history of breast cancer. Migraines may worsen with hormonal birth control, and the possibility of blood clots does still exist for some. Pills containing estrogen are not advised for those at risk of cardiovascular disease or hypertension or for those who smoke. Finally, research is being done to determine if birth control pills contribute to vaginal atrophy and painful sex.

Also, and this is a biggie: the Pill does not protect against sexually transmitted diseases such as herpes, gonorrhea, genital warts, or HIV.

When can I go off birth control?

Because the Pill can mask menopause symptoms – including causing “withdrawal bleeds” during the sugar-pill week – a woman on mixed-hormone oral contraception may not know she’s completed the transition to menopause. Getting an FSH (follicle-stimulating hormone) test during the 7-day “off” period may indicate if a woman is in menopause. At that point, some research indicates, a woman can transition from oral contraceptives to HRT (hormone replacement therapy), if she decides to go that route.

There are natural ways to manage menopause symptoms that are highly effective for some women. There are lifestyle choices that can make life during this challenging time easier for others. And for some women, there are birth control pills. There are risks to oral contraceptives, higher for some women than others, so please – do your research, talk to your doctor, make sure the information you’re getting is recent and reliable.

We’d love to know what you’re doing to make perimenopause/menopause more comfortable. Fill us in in the comments below, or share on the genneve Facebook page or in Midlife & Menopause Solutions, the closed genneve Facebook group.

*The information in this blog is for educational purposes only. To understand your potential risks and benefits, talk to a doctor.

Interview Transcript

Dr. Jones: You’ve been so good about your family planning. You’ve always used birth control, but when can you stop? This is Dr. Kirtly Jones from Obstetrics and Gynecology here at University of Utah Health Care and this is The Scope.

Announcer: Covering all aspects of women’s health, this is “The Seven Domains of Women’s Health” with Dr. Kirtly Jones on The Scope.

Dr. Jones: So you’ve spent all your life planning your children. You had your babies when you wanted them. You didn’t have any extra babies. You’re really been good at it, but when can you stop? The answer is when you or your partner are using some form of really good birth control so you can stop. If your partner has a vasectomy, well, that’s great.

Now, a really good form of birth control was menopause. So let’s talk a little bit about your contraceptive method and menopause. First, fertility, we know, declines starting at about 30. We know that women who are trying to get pregnant sometimes struggle in their late 30s and certainly do in their 40s. The difficulty is that a pregnancy in your 40s that’s unplanned is a definite problem because women in their 40s who get pregnant, even though they’re not very fertile, do have higher risks of complications in pregnancy, like high blood pressure and diabetes.

They’re actually more likely, believe it or not, to have twins. And they have more complications in terms of blood loss and a whole lot of other problems just with the pregnancy. And of course, we all worry about the difficulties in chromosomal abnormalities in our babies that increases in women after their 30s. So women are more likely to have complications in pregnancy. They are more likely to have a baby with a chromosomal anomaly like Down syndrome and importantly, they are more likely to miscarry. And by the end of your 40s, you are really likely to miscarry.

However, you don’t want to get pregnant even though your chances are low. So when, even if you’re being very careful, when is it time to stop? Okay. So let’s now talk about menopause. Menopause is defined as when you haven’t had a period for a year. Then that last period a year ago is your menopause. Now, you have to be of the right age.

So the average 20-year-old who hasn’t had a period for a year is probably not in menopause. She hasn’t run out of eggs. She may have another reason for not having her periods. But women in their late 40s and early 50s who haven’t had a period for a year are very, very likely to be in menopause. So if you haven’t had a period for a year, then you’re likely in menopause and you can stop using your contraceptive method.

However, it’s difficult to know if you’re in menopause based on your periods if you’re using a contraceptive method that changes your periods. So let’s take, for example, birth control pills. Birth control pills block ovulation but give you hormones that make you have a period every month. So you can be in menopause, have no more eggs, be completely infertile, but because you’re taking the pill, you’ll have a period every month.

So how do you know, if you’re on birth control pills, that you’re in menopause? Well, the difficult answer is you have to stop your pills and see what happens. If you stop your pills, and you’re about 52, and you don’t have a period for six months, then you’re in menopause. But what happens if you are 52, and you’re still fertile, and you stop your pills, and you get pregnant? Well, the option is, of course, to stop your pills, see what happens, and use a different method, a barrier method, use condoms, use foam. Remember, you’re not very likely to get pregnant because you’re not very fertile and you’re not very likely to stay pregnant because you’re likely to miscarry. So that’s one option.

The other option is to say, “Well, why don’t I just stay on my pills because going through the perimenopause,” those years when your periods are totally unpredictable and not very pleasant, “why don’t I stay on these nice little periods that I like on the pill until I’m about 54?” We know that at 54, about 90% of women have gotten through menopause. At 50, the average age of menopause, only 50% of women are menopausal. But by 54, about 85 to 95% of women are menopausal. So you just stay on your pills and stop at 50 and you’re very likely to be done.

Let’s talk about an IUD that has hormones in it. For women who have an IUD with hormones in it, many of those women have very light periods or no periods at all so you may not know that you’re in menopause. You may have some hot flushes because your estrogens have gone away. You may use a blood test, which doesn’t work very well for women on the pill, but it can work for people with a hormone-containing IUD. You could do a blood test called FSH and if that is really high, then it’s likely, not guaranteed, but likely, that you’ve run out of eggs and you’re in menopause.

Or you can just stay on that IUD that has some hormones in it until you’re about 54. And many women in their early 50s who have hot flushes may want to take a little estrogen and they have the progestin protection. They protect their uterus lining against abnormalities with that little hormonal IUD. So wait until you’re a little older and then take your hormonal IUD out.

If you’re taking a shot like Depo-Provera, about 80% of women on Depo-Provera don’t have periods so you won’t know when you’re in menopause. Well, the same kind of strategy goes with Depo-Provera as it does with the hormone-containing IUD. You can just wait till you’re a little older or you can stop, use a backup method. You can stop your shots, use a backup method, and wait and see if you start your periods again.

So this is kind of a complicated question. The good news is that for women who stop their method, whatever it might be, at 50, then, in fact, the chances of getting pregnant are very low. How low is low for you, though? If the chances of getting pregnant and having a baby is 50 to 1 in 100, is that a number that you’re willing to take a risk for? Not me. For me, that’s no, I wouldn’t take a 1 in 100 risk of a baby, that with all the complications of a pregnancy at 50 is. So I was much more willing to push my contraception out to 54 and then say, “Now I’m ready to be done.”

So it’s a personal choice. It’s one that you discuss with your partner, with your family, if that’s what you want to do, in terms of what their thinking about future childbearing, what kinds of risks are they willing to take if you do get pregnant? But definitely talk with your clinician because there are some options that are really good ones to make this transition with low fertility, but still some fertility, and some good therapy for menopausal symptoms.

So many women actually use a low-dose birth control pill to help them with their menopause symptoms. So that’s the difficult answer for a difficult question, but I want to say good for you for having been such a good contraceptor all these years. And thanks for joining us on The Scope.

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