- Not a Factor
- Will I start menopause even though I am on the pill?
- Birth Control and Menopause: what do we need to know?
- First question: for those in perimenopause, should we stop taking the Pill?
- Second question: Do birth control pills or using a hormonal IUD help with perimenopause?
- Third question, then: Does birth control actually delay menopause?
- OK, fourth question: If we’ve been taking oral contraceptives for 20+ years, how will we know if perimenopause has started?
- Question five: Are there health risks to continuing to take the Pill?
- So hit us—what are the risks?
- Birth Control’s Effect on Menopause Symptoms
- Contraception for the older woman
- Barrier methods
- Hormonal methods
- Progestogen-only methods
- Other contraceptive methods
- Emergency contraception
- When to stop contraception
- Hormone replacement therapy
- Birth Control and Perimenopause
- Knowing the Symptoms of Perimenopause
- Taking Birth Control Pills During Perimenopause
- Determining if You Are in Perimenopause
- Continuing Birth Control Pills to Manage Perimenopause Symptoms
- Choosing the Right Birth Control During Perimenopause
Not a Factor
Here are three things you might think would influence menopause age, but don’t:
- Age at first period. Although the average age of menarche (onset of first menstrual period) has been getting younger in U.S. women, there hasn’t been a corresponding shift in the average age at menopause. The average age at menarche is now about 12.4 years old, down from 13.3 in women born prior to the 1920s, but the average age at menopause has been around 51.5 for decades. “You would assume that a woman only has so many cycles in her life and if she menstruates later, she’ll reach menopause later, but that doesn’t seem to be true,” Cedars says.
- Pregnancy and breastfeeding. These have no impact on menopause age.
- Use of hormonal birth control methods. “Even if you’re using a birth control method that stops ovulation, it doesn’t stop the loss of follicles, the constant process of the ovary taking them from the resting pool of eggs,” Cedars says. “All the follicles available in the cohort that month die away, even if you’re not ovulating, so birth control doesn’t appear to delay menopause.”
There is no way to delay menopause; it can only be sped up, not slowed down, by external factors.
And there are some factors that are still unknowns. For instance, researchers are studying bisphenol A (BPA), a chemical used to make certain plastics, in relation to various cancers as well as the reproductive system and metabolic processes.
Could BPA exposure influence age at menopause? “My guess would be no, since the age of menopause hasn’t changed much over the years as we’ve been exposed to more of these environmental toxins, but research will be exploring the role of substances like BPA in ovarian function,” Santoro says.
Will I start menopause even though I am on the pill?
Thank you for your question. Also called a woman’s “change of life,” menopause marks the time in which one’s periods stop (defined in retrospect after having no menstrual cycles for a full year) and eggs are no longer produced by the ovaries. Most women reach menopause after age 45, with the average age being around 51 years old. During the time around menopause, the body gradually makes less estrogen and progesterone. Symptoms associated with decreases in these hormones include hot flashes, night sweats, difficulty sleeping, trouble focusing and mood swings, and they may occur for months or years after menopause, although some women have no symptoms at all other than the loss of menstrual periods.
I consulted with Dr. Gary Glasser of Atlanta Gynecology and Obstetrics about the effects of birth control pills (also called “the pill”) such as Seasonique on menopause. He explains that the pill suppresses ovulation and as such may be an option for healthy women before menopause (in “menopause transition”) desiring to prevent pregnancy or control one’s menstrual cycle.
As far as how the pill affects menopause, the timing of a woman’s menopause is determined by factors such as genetics, and the pill will not change this already-determined “endpoint” of fertility. It can, however, make it difficult to assess whether a woman has reached menopause because her menstrual cycles cannot be evaluated accurately. Depending on the formulation of the pill, a woman may or may not have a monthly “bleed” that simulates a regular menstrual period. The estrogen and progesterone hormones in the pill may also prevent typical menopausal symptoms such as hot flashes.
Confirming menopause can be done only after the woman discontinues the pill (while using a nonhormonal method to prevent unplanned pregnancy). Options include checking a hormone marker for menopause (called follicle stimulating hormone, or FSH) several weeks after stopping the pill, or waiting for 12 months of no menstrual periods. The testing can be done at any age; by age 55, more than 90 percent of women will have reached menopause.
For any questions or more information, I encourage you to consult with your own physician.
Birth Control and Menopause: what do we need to know?
Does using birth control delay menopause? Does it increase the risk of breast cancer or heart disease in menopausal or perimenopausal women? After many years on the Pill, how will I know it’s safe to go off it?
For answers to our birth-control-and-menopause questions, we turned to Dr. Sherry Ross, award-winning OBGYN and author of the book She-ology, a look into women’s health beyond the doctor’s office.
Dr. Sherry Ross
First question: for those in perimenopause, should we stop taking the Pill?
“First,” Dr. Sherry told us, “be sure you understand this: until you’ve had no periods for a year, you can still get pregnant.
“Part of the confusion is around definitions: The true definition of ‘menopause’ is when you don’t have a period for one full year, but many women suffer from disruptive symptoms for a few years leading up to full cessation of periods—that’s called ‘perimenopause.’ As I said, until you are officially in menopause—meaning no periods for a full year—you can potentially get pregnant, so be sure to use some form of contraception. If you are single and dating while in menopause, you may not have to worry about getting pregnant, but you do have to protect yourself against sexually transmitted infections, so make sure your partner wears a condom.”
So, re: birth control, keep on keeping on until one year with no periods, and re: condoms, always always always outside of committed, monogamous relationships. Check.
Second question: Do birth control pills or using a hormonal IUD help with perimenopause?
“Oral contraceptives can mask some of the symptoms of perimenopause and menopause,” Dr. Sherry told us. “That’s one of the benefits. Women on the Pill may have fewer, less-intense hot flashes, more ‘normal’ periods when other women are all over the menstrual map, and they might have more modulated emotional swings, which can be a huge benefit in their personal and professional lives. That’s why many doctors—myself included—prescribe low-estrogen birth control pills to non-smoking women having a rough menopause or to make the transition into menopause easier.”
Third question, then: Does birth control actually delay menopause?
Short answer: No. Here’s why:
“Menopause is a time when your ovaries stop producing estrogen and your female hormone reserves are depleted. Known factors that can affect what age you enter menopause include your genetic predisposition, knowing when your mom went through the change, chromosomal abnormalities such as Turner Syndrome, very thin or obese women, long smoking history, needing chemotherapy or radiation therapy, those with autoimmune diseases and epilepsy.
“It’s clear that short- and long-term stress, such as extreme weight loss and weight gain, can offset your hormones, causing irregular periods. The extent this type of significant stress has on your endocrine system, causing hormone adrenal depletion and possibly affecting menopause, is not as clear.
“There is an association between extreme and long-standing exercising causing weight loss which can offset your hormones and cause early menopause. Excessive exercising creates a hormonal imbalance, causing irregular ovulations. It’s less likely short-term exercising mixed in with months of not exercising could cause a cascade of events leading to an early hormonal depletion.
“So there are some things that can bring on early menopause, but being on the birth control pill does not affect when you begin menopause. The Pill can mask the symptoms of menopause and, as I said, many women depend on it to help ease the transition into menopause.”
OK, fourth question: If we’ve been taking oral contraceptives for 20+ years, how will we know if perimenopause has started?
“The best way to know if you are in menopause while taking the birth control pill is to check your hormonal levels at the end of the pill-free week. Some women may even notice hot flashes during the pill-free/placebo week since they are not taking estrogen that’s normally in the active pills. Your doctor can conduct a simple blood test that determines if your follicle-stimulating hormone level (FSH) has reached menopausal levels.”
Question five: Are there health risks to continuing to take the Pill?
Says Dr. Sherry: “As long as you’re not a smoker over the age of 35, and you don’t have any contraindications of being on the Pill (high blood pressure, a history of blood clots, liver disease, breast or uterine cancer, strokes or migraine headaches), there are no health risks to taking the Pill during the first couple of years of menopause. The birth control pill stabilizes your hormones and keeps you physically and mentally balanced.”
And, according to Dr. Sherry, there’s even more good news.
Wait. There’s good news? About menopause?
“There’s evidence that taking birth control pills reduces the risk the risk of ovarian and uterine cancers. It may also help with rheumatoid arthritis.”
OK, that’s all terrific, but there have to be drawbacks.
So hit us—what are the risks?
Said Dr. Sherry: “As I said, hormonal birth control is not for women who smoke, particularly if they’re 35 or older. Birth control pills may increase your risk of strokes and blood clots, and that risk is exponentially higher for smokers over 35. Yet another reason to quit!”
We completely agree. Anything else?
“Studies are still being conducted into hormonal birth control and breast cancer. But unless a woman has a history of breast cancer or other factors that make her high risk, she should feel comfortable taking low-dose birth control pills to control perimenopausal or menopausal symptoms,” Dr. Sherry told us.
“The best first step is to have a frank and open discussion with your doctor. And don’t be embarrassed or shy—I can tell you from personal experience that almost nothing shocks a doc! Menopause is a normal, natural process and part of life, though women may experience it differently. Your doctor is here to help you understand what’s happening and alleviate symptoms that are interfering with your quality of life. There are solutions. You can feel better. And that’s the best news of all.”
Sheryl A. Ross, M.D., “Dr. Sherry,” is an award-winning OBGYN, author, entrepreneur and women’s health expert. The Hollywood Reporter named her as one of the best doctors in Los Angeles, Castle Connolly named her as a Top Doctor in the specialty of Obstetrics & Gynecology, and she was selected as a 2017 Southern California Super Doctor. Dr. Sherry continues the conversation of women’s health and wellness in her monthly newsletters and on DrSherry.com.
Dr. Sherry blogs for Huffington Post, Maria Shriver, Greatist, SheKnows, HelloFlo, All Things Menopause, and Gurl, and we are thrilled to welcome her to the genneve community!
Birth Control’s Effect on Menopause Symptoms
Most of us associate birth control pills with preventing pregnancy. While that’s certainly true, it turns out that the pill may also minimize symptoms associated with approaching menopause. In fact, your doctor might suggest them to help if your periods go haywire. On the other hand, if you’ve been on birth control pills to prevent pregnancy, the changes they cause may actually keep you from noticing early signs of menopause.
Signs of menopause can occur up to several years before a woman’s final period, a transition time known as perimenopause. You don’t technically enter menopause until a full year has passed without a period. These years can seem like an eternity if you have severe menopause symptoms, such as hot flashes. Menopause symptoms vary from woman to woman, but in general they also include changes in your period. Your menstrual flow could be lighter or heavier and more frequent or farther apart during the perimenopause years. Both hot flashes and irregular periods may be helped with birth control pills.
Given that a woman can become pregnant up until her last period has occurred, women in perimenopause who do not want any more children must consider their birth control options. Many choose birth control pills, most of which contain a combination of the hormones estrogen and progestin. How will these synthetic hormones affect diagnosing menopause?
“Birth control pills (also known as oral contraceptive pills) mask many of the signs of menopause,” says Barbara DePree, MD, director of Women’s Midlife Health Services at Holland Hospital in Holland, Mich. “They work by suppressing the ovarian function; therefore, there is no significant output of estrogen or progesterone from the ovary while on the pill. Instead, oral contraceptive pills add back a fixed amount of synthetic estrogen and progestin daily while the ovary sits by idly.”
This means that while birth control pills can relieve many of the unpleasant side effects of menopause, they can also mask the fact that a woman has undergone “the change” and make diagnosing menopause more difficult.
“Birth control pills do not specifically affect the timing of menopause,” says Robert Tomaro, Jr., MD, a physician in the department of obstetrics-gynecology at Jersey Shore University Medical Center in Neptune, N.J. and immediate past president of the Monmouth County Medical Society. In other words, a woman’s body is designed to reach menopause at a certain age regardless of whether she is taking birth control pills. The pill simply camouflages its pending arrival.
Is It Menopause or the Pill?
Ultimately the main way for a woman using birth control pills to know if she has reached menopause is to stop taking the medication and see what happens. If she is of menopausal age — on average, menopause occurs at age 51 — and does not have a period for a year, then it’s probably safe to say she has been through menopause. For a faster determination of whether or not menopause has occurred, doctors can draw blood and measure the amount of FSH (follicle-stimulating hormone).
Related: Choosing a Birth Control Pill
Keep in mind that birth control pills do carry their own risks, including the possibility of high blood pressure, blood clots, heart attacks, and strokes with the dangers increasing with age and especially in women who smoke.“Most women are good candidates for oral contraceptive pills in perimenopause,” says Dr. DePree. “However, a careful health history should be taken to look for contraindications to birth control pill use — and there are absolute and relative contraindications that are too extensive and complicated to just make a simple list.”
Bottom line: As with all medications, always talk to your doctor to make the right choice for your particular situation.
Contraception for the older woman
Many women are aware that their fertility declines from their mid 30s and think they can stop using contraception once they are in their 40s. They wrongly assume – because their fertility is lower, they have less sex and their periods may have become irregular – that contraception can be abandoned. However, women do still get pregnant in their late 40s and even into their 50s (without using assisted reproduction techniques), so contraception should continue to be used every time they have sex if pregnancy is to be avoided.
An unplanned pregnancy at any age can pose problems, but particularly so for a woman in her 40s who may be beginning to enjoy more freedom as children grow up. Furthermore, a pregnancy in older women is often associated with an increased number of complications such as miscarriage, high blood pressure, diabetes and chromosomal problems with the baby, and consequently will need more careful monitoring.
In recent years there have been many advances in contraception, and new methods may have additional health benefits (such as lighter periods) as well as providing excellent contraception. Women’s needs change as they get older and a method that may not have been ideal when she was younger may become much more suitable.
This factsheet comments on various methods of contraception and discusses how appropriate they are for women in their 40s. It should be read in conjunction with the more detailed fact sheet on Contraception available from the Women’s Health Concern website.
With rates of divorce and separation increasing, many women are ‘back on the scene’ and should use a barrier method of contraception to prevent sexually transmitted infections (STIs) even if they have been sterilised or are using another method of contraception. Chlamydia, gonorrhoea, HIV and other STIs are on the increase in women in their 40s and 50s, so it is a good idea to be screened for infection before starting a new relationship.
The male condom
This is an effective method for this age group, although some men may find them difficult if they have not used them for several years and may experience erection difficulties. As hormone levels change many women experience vaginal dryness which can cause discomfort during intercourse. Vaginal lubricants can be helpful, but care should be taken as any oil-based lubricant can cause condoms to split, leading to a risk of pregnancy and infection.
The female condom
Some women may find these awkward if they have not used them before. They are well lubricated, so vaginal dryness should not be a problem.
The diaphragm and cap
Again, some women may find these awkward to use if they have not used them before, and if suffering from a small prolapse or stress incontinence may find them uncomfortable. Spermicides are an inherent part of using a diaphragm and these will provide additional lubrication. Women who have previously used a diaphragm or cap usually have no problem with these methods and can continue with their use right up until the menopause.
The combined pill
The combined pill can safely be used until the age of 50, so long as there are no health risks such as smoking, obesity, high blood pressure etc that could lead to heart, stroke or blood clotting problems. Your doctor or nurse will be able to advise on this.
The pill has several advantages for women in this age group as it will regulate periods, may help to maintain bone mineral density (which is reduced after the menopause), may reduce blood loss and period pains and may also relieve some troublesome menopausal symptoms such as hot flushes and night sweats.
The contraceptive patch and vaginal ring
The efficacy, benefits, risks and side-effects are similar to the combined pill and again can be safely prescribed until 50 years old to those with no health risks.
All progestogen-only methods may cause irregular bleeding or even no bleeding at all. The absence of bleeding doesn’t necessarily mean that the menopause has been reached – it is just a side effect of the method of contraception. Medical advice should be sought if bleeding occurs after a long time with no periods.
The progestogen-only pill (POP or mini-pill)
The progestogen-only pill is suitable for older women and can safely be used up until the age of 55.
The contraceptive injection
Use of this method may continue until the age of 50. There has been some concern that the injection may reduce bone mineral density and increase the risk of osteoporosis. Women who have lifestyle or risk factors for osteoporosis (smokers, previous fractures, steroid use, family history etc) may wish to consider another method of contraception.
The implant is suitable until the age of 50 and there are no anxieties about loss of bone mineral density with this method.
Intrauterine system (IUS)
The hormone-releasing IUS is not only a highly effective method of contraception but it also significantly reduces the amount of bleeding and period pain. This is particularly important as a considerable number of women complain of heavy periods and ‘flooding’ in their 40s. Additionally, if a woman decides to start HRT during the perimenopause, then the IUS can be used as the progestogen element of HRT.
The IUS is licensed for contraception for 5 years but if it is inserted over the age of 45 years it could remain in place for 7 years after discussion with your doctor or nurse. It is only licensed for 4 years if used for HRT but is known to be effective for this purpose for 5 years.
Other contraceptive methods
Intrauterine devices (IUD)
An IUD is a suitable method but may cause periods to become heavier or more painful, so may not be a good idea if periods are already causing a problem. If an IUD (of any type) is inserted over the age of 40 years then it can remain, without being changed, until the menopause. It should be removed one year after periods stop if this is over the age of 50 or two years after periods stop if this is under the age of 50.
Male and female sterilisation
Sterilisation (both male and female) is the most commonly used method for couples in their 40s. However, sterilisation is a surgical procedure and it may not be justified for a woman with low fertility to undergo such a procedure when there are so many other highly effective options available.
Natural family planning
Women who have already been using natural methods of contraception (timing of periods, changes in cervical mucus and body temperature) can usually manage to continue to do so until the perimenopause. However this can be more difficult to teach to beginners at this stage in life due to variable cycle lengths and erratic ovulation.
Emergency contraception can be used if a woman has had unprotected sex or if a form of contraception has failed (a split condom or missed pills). There are two forms: the emergency contraceptive pill or the emergency intrauterine device (IUD).
There is no age limit for using emergency contraceptive pills (levonorgestrel or ulipristal) and they can be easily obtained from your doctor or in pharmacies without a prescription. The emergency IUD has the advantage that it can remain in place and is an effective method of ongoing contraception.
When to stop contraception
Contraception should be continued for at least one year after your last period if the periods stop after the age of 50, and for two years if your periods stop before the age of 50. This is because sometimes periods may restart even after several months with no bleeding.
However, if you are using progestogen-only hormonal contraception you may well have only occasional periods or no periods at all, thus making it difficult to tell if you are menopausal. These methods can be safely used until the age of 50 (55 years for the progestogen-only pill or the IUS). Your doctor may recommend a blood test which would give some guidance as to whether you are menopausal.
If using combined hormonal contraception you will experience regular periods or withdrawal bleeds which again would mask one of the signs of the menopause. Blood tests are not reliable and not recommended if you are using combined hormonal methods.
Hormone replacement therapy
The average age for the menopause in the UK is 51 years but women in their 40s may start experiencing menopausal symptoms and consider taking hormone replacement therapy (HRT).
It is important to realise that HRT is not a method of contraception. If periods have not stopped before starting HRT then a method of contraception should be used in addition to HRT. Suitable methods to consider would be barrier methods, an IUD, the progestogen-only pill or the IUS. The IUS has the additional advantage of providing the progestogen component of HRT and so minimises bleeding problems and other side-effects that might occur from the progestogen.
Once HRT has been started, it can be difficult to know when contraception can be stopped since HRT will often produce regular monthly bleeds. It is best to continue contraception alongside HRT until the age of 55 as the vast majority of women will be menopausal by then.
Birth Control and Perimenopause
If you’re of a certain age and experiencing irregular periods, hot flashes, and insomnia there’s a good chance you’ve entered perimenopause, the time leading up to menopause. How long perimenopause lasts, and how severe symptoms like sleepless, sweaty nights are, varies by person.
For women who take birth control pills, however, the signs of perimenopause might not be so obvious. This is because the hormones in birth control can mask perimenopause symptoms.
After all, as long as periods continue, even sporadically, pregnancy is still possible. Contraception is important for these women. But is birth control necessary and safe during perimenopause?
Knowing the Symptoms of Perimenopause
Before answering that question, first it’s important to define perimenopause. Marked by a reduction in estrogen and progesterone, perimenopause is the transitional time before menopause. It’s not until a woman has been without a menstrual cycle for one year that she has officially entered menopause.
On average, perimenopause lasts four years, and the average woman enters menopause at age 51. However, these ranges can vary widely. Perimenopause can begin during a woman’s early 40s or even sooner.
One of the most important steps in navigating the changes perimenopause brings is to know the common symptoms, which include:
- Irregular periods
- Hot flashes
- Insomnia or other sleep problems
- Night sweats
- Decreased libido
- Mood swings
- Appetite changes
- Vaginal dryness
Taking Birth Control Pills During Perimenopause
The most common birth control pills contain a combination of synthetic estrogen and progesterone, the hormones responsible for a woman’s menstrual cycle. At the onset of perimenopause, estrogen and progesterone levels decline, usually bringing on the symptoms mentioned above.
However, since combination birth control pills release estrogen and progesterone into the body, women who take them may not have perimenopause symptoms. Some women still experience them, but to a lesser degree, and others may notice the signs only when they take the inactive pills.
Determining if You Are in Perimenopause
Unlike pregnancy, there is no test you can take to definitively tell you if have reached perimenopause. If you observe perimenopausal symptoms while taking the placebo pills in your birth control pack, this is often a good indicator that your body is in perimenopause.
Some women who are using birth control choose to stop taking the pills because they want to let the body’s natural hormones take over, possibly giving them a more conclusive answer. If symptoms persist, you are likely in perimenopause. If, after halting the birth control, the symptoms disappear, they could have been side effects of the medication, meaning you are not in perimenopause.
It may take anywhere from four weeks to several months for the body and its hormones to regulate after you have ceased taking birth control. There is also a possibility that you have already reached menopause, and menstruation might not be present at all.
Continuing Birth Control Pills to Manage Perimenopause Symptoms
Taking birth control during perimenopause has several benefits. Doing so keeps hormone levels consistent, reducing the fluctuations that produce perimenopause symptoms, many of which can significantly and negatively impact women’s lives.
The obvious benefit is contraception, and it is necessary for many women experiencing perimenopause. In fact, in the United States, women in their 40s have the second highest rate of unintended pregnancy (teens have the highest). In addition, birth control pills can protect perimenopausal women from ovarian and uterine cancers, while also helping to prevent bone loss that can lead to osteoporosis.
In general, birth control is safe for nonsmoking women who are older than 35, as most perimenopausal women are, and who do not have a history of any of the following:
- High blood pressure
- Estrogen-dependent cancer
- Heart disease
- Blood clots
Choosing the Right Birth Control During Perimenopause
If perimenopause causes a natural reduction in estrogen and progesterone levels, how do you know which birth control medication is best for your body?
Most of the time, perimenopausal women will benefit from a combination birth control method, meaning one containing both estrogen and progesterone. Combination pills are the most common. The other type of birth control is the progestin-only pill, sometimes called the mini pill. This is not usually recommended for perimenopausal women because it does not replace the body’s naturally declining estrogen.
Narrowing down the choices, many health experts recommend low-dose birth control pills for women in perimenopause. The reduced amount of estrogen, specifically 20 micrograms or less, is considered safer for women as they approach menopause. Companies like Nurx provides access to several low-dose combination birth control options. They all have 20 micrograms of Ethinyl estradiol, which is the synthetic version of estrogen. The exceptions are Lo Loestrin FE and Nuva Ring, containing 10 and 15 micrograms, respectively.
As with all medications, each drug has side effects. In general, side effects of birth control include breakthrough bleeding, nausea, breast tenderness, headaches, weight gain, mood swings, decreased libido, and vaginal discharge changes.
This blog provides information about telemedicine, health and related subjects. The blog content and any linked materials herein are not intended to be, and should not be construed as a substitute for, medical or healthcare advice, diagnosis or treatment. Any reader or person with a medical concern should consult with an appropriately-licensed physician or other healthcare provider. This blog is provided purely for informational purposes. The views expressed herein are not sponsored by and do not represent the opinions of Nurx™.