The perimenopausal transition
Perimenopause, meaning 'around menopause,' is the time when your body naturally transitions toward menopause. It can last for several years, typically beginning in a woman's mid-to-late 40s. During this period, hormone levels like estrogen and progesterone fluctuate erratically, which can lead to a variety of symptoms, including irregular periods, heavy bleeding, and hot flashes.
Even with these hormonal shifts, ovulation can still occur, meaning pregnancy is still a possibility until you have gone 12 consecutive months without a period. In fact, nearly half of all pregnancies in women over 40 are unplanned. Continuing a reliable method of contraception, like the pill, is essential for sexually active women who want to avoid pregnancy during this stage.
Benefits and risks of using birth control pills in your 40s and 50s
Continuing to use birth control pills can offer several benefits beyond pregnancy prevention during perimenopause and up to menopause. However, it's also important to be aware of the associated risks, which can be influenced by age and lifestyle.
Benefits
- Relief from perimenopausal symptoms: Hormonal birth control can help manage many of the challenging symptoms of perimenopause. The steady dose of hormones can regulate unpredictable cycles, reduce heavy bleeding and cramps, and alleviate vasomotor symptoms like hot flashes and night sweats.
- Consistent cycle: Many pills create a regular, predictable withdrawal bleed, which can be reassuring for women experiencing unpredictable periods. For those who prefer, some birth control regimens allow for fewer or no periods at all.
- Reduced cancer risk: Long-term use of combined oral contraceptives (the pill) is associated with a reduced risk of certain cancers, including ovarian, endometrial, and colorectal cancers.
- Bone density protection: Studies suggest that taking combined hormonal birth control in your 40s can help preserve bone mineral density, reducing the risk of osteoporosis after menopause.
Risks
- Increased risk of blood clots: The primary concern with combined hormonal birth control for older women is the increased risk of venous thromboembolism (VTE) or blood clots, especially in women over 35 who smoke, have high blood pressure, or a history of heart disease.
- Masking menopause: The hormones in the pill mask the natural decline in your body's hormone levels. This can make it difficult to know when you have truly reached menopause and are no longer fertile.
- Side effects: Some women may experience side effects similar to those of perimenopause, such as mood swings, headaches, or decreased libido, making it hard to differentiate the cause.
Comparison of contraception options for older women
Navigating contraception options in your 40s and 50s involves weighing various factors. A discussion with your healthcare provider is essential to determine the best choice based on your health history and lifestyle. Here is a comparison of common methods:
| Method | Best for... | Potential drawbacks |
|---|---|---|
| Combined Oral Contraceptives | Regulating periods, alleviating perimenopausal symptoms, and preventing pregnancy until age 50 or older, provided no risk factors exist. | Increased risk of blood clots, especially in smokers over 35; masks symptoms; not recommended past age 50 if high risk. |
| Progestogen-Only Pill (Minipill) | Women over 35 with risk factors like smoking or high blood pressure; can be used until age 55. | May cause irregular bleeding or no periods; doesn't offer estrogen benefits for some symptoms. |
| Hormonal IUD (e.g., Mirena) | Long-term, highly effective contraception with significant reduction in heavy bleeding; can provide the progestogen component of HRT. | May cause irregular bleeding patterns; does not mask menopausal symptoms. |
| Copper IUD | Those who want non-hormonal contraception; effective for 10 years. | Can cause heavier or more painful periods, which may be undesirable if already experiencing heavy bleeding in perimenopause. |
| Barrier Methods (Condoms) | Anyone needing protection from STIs, especially with new partners; non-hormonal. | Less effective at preventing pregnancy; can be disruptive. |
How to know you have reached menopause while on the pill
Because hormonal birth control provides a consistent dose of hormones, it overrides your natural cycle and masks the signs of menopause. The most definitive way to know if you've entered menopause is to stop the hormonal method and observe your body's natural cycle.
Steps to confirm menopause
- Consult your doctor: Discuss stopping your current method, particularly a combined pill, around the typical age of menopause (average age 52). Your doctor will help you weigh the risks and benefits.
- Switch to a non-hormonal method: During the observation period, it's essential to use an alternative, non-hormonal method like condoms to prevent unplanned pregnancy.
- Monitor your cycle: For most women, the absence of a period for 12 consecutive months without hormonal intervention is the defining sign of menopause. If you are over 50, a shorter observation period may be sufficient.
- Consider blood tests: Your doctor may also recommend checking your hormone levels, specifically your follicle-stimulating hormone (FSH) level, to help determine your menopausal status. However, FSH tests can be unreliable while still on hormonal birth control.
Once menopause is confirmed, you can stop using contraception entirely. At this point, your doctor can also discuss other options like Hormone Replacement Therapy (HRT) to manage lingering menopausal symptoms. For more information on women's health throughout life, consult authoritative sources like the Office on Women's Health at Office on Women's Health.
Conclusion
For many women, continuing to take the pill until menopause is a safe and effective way to manage perimenopausal symptoms and prevent pregnancy. This strategy is especially suitable for women who do not have contraindications like smoking or high blood pressure. The main trade-off is that hormonal birth control masks the natural signs of menopause, requiring a temporary cessation of the pill under a doctor's supervision to confirm the transition. Ultimately, the decision to continue or stop contraception as you age is a personal one that should be made in close consultation with your healthcare provider to ensure your continued health and well-being.
