Why Hormonal Birth Control Masks Menopause
Hormonal birth control, such as the combined oral contraceptive pill, patch, or ring, works by supplying synthetic estrogen and progestin to your body. This regulates your menstrual cycle, prevents ovulation, and often eliminates the irregular periods that are a hallmark of perimenopause. As a result, the hormonal fluctuations naturally occurring during perimenopause are suppressed, hiding classic symptoms like irregular bleeding, hot flashes, and night sweats.
For those on combination pills, the monthly withdrawal bleed that occurs during the placebo week can continue even after menopause has occurred, which further complicates diagnosis. Progestin-only methods, including the mini-pill, hormonal IUD, and implant, can also cause irregular bleeding or stop periods entirely, making it hard to track your natural cycle.
The Role of FSH Testing
Follicle-stimulating hormone (FSH) is a hormone that increases as the ovaries wind down production of estrogen and eggs. While a high FSH level can indicate menopause, hormonal birth control suppresses the body's natural hormone production, including FSH. A standard FSH test will therefore not be accurate while you are actively taking combined hormonal contraception.
The process for testing FSH levels safely
- Consult your healthcare provider: Before making any changes to your medication, speak with your doctor. They can discuss your symptoms, age, and individual health risks.
- Pause combined hormonal contraception: For the most accurate FSH reading, your doctor will likely advise you to stop taking your combined hormonal birth control (pills, patch, or ring) for a specific period, typically around six weeks.
- Use backup contraception: It's crucial to use a non-hormonal backup method, like condoms, during this time. Even if you haven't had a period in a while, you can still ovulate and become pregnant during perimenopause.
- FSH testing schedule: For confirmation, multiple blood tests are usually required. The Reproductive Health Access Project recommends testing FSH levels twice, one to two months apart, with both levels over 30 IU/L to confirm menopause.
Hormonal vs. Non-Hormonal Contraception
If you are approaching the average age of menopause and suspect you may be in perimenopause, the type of contraception you use significantly impacts your ability to monitor your body's natural changes. The table below compares how different methods interact with menopause.
| Feature | Hormonal Contraception (Pill, Patch, Ring) | Non-Hormonal Contraception (Copper IUD, Condoms) |
|---|---|---|
| Effect on Menstrual Bleeding | Stabilizes or eliminates bleeding, masking natural irregularities. | No impact on your natural menstrual cycle or bleeding patterns. |
| Effect on Menopause Symptoms | Often alleviates or masks symptoms like hot flashes and mood swings. | Does not mask symptoms, allowing you to track natural hormonal shifts. |
| FSH Test Accuracy | Unreliable while in use; requires pausing medication for accurate results. | No effect on natural FSH levels, so testing can be more straightforward. |
| Age Considerations | Risks may increase with age, and doctors may recommend switching after 50. | Safe to use indefinitely; no increased age-related risks from the method itself. |
When To Consider Stopping Hormonal Birth Control
Your healthcare provider may suggest a trial period off hormonal contraception based on your age and symptoms. This is often considered around age 51 or 52, the average age of menopause. If you stop hormonal contraception and don't experience a period for 12 consecutive months, then menopause can be confirmed. This provides a clearer picture than hormonal testing alone, especially for those in the perimenopause phase where FSH levels can fluctuate unpredictably.
Other important factors to discuss with your doctor:
- Existing symptoms: If you are experiencing hot flashes, night sweats, or other symptoms despite being on the pill, it may be a sign of perimenopause.
- High-risk factors: For women with risk factors for blood clots, heart disease, or breast cancer, it may be safer to switch to a non-hormonal method or explore menopause-specific treatments.
- Fertility needs: As long as contraception is required, using a reliable backup method is essential during any period off hormonal birth control.
- Menopause hormone therapy (MHT): If your primary goal is to manage menopause symptoms, your doctor might recommend transitioning to MHT instead of continuing birth control.
Conclusion
Testing for menopause while on birth control is not as simple as a single hormone test because hormonal contraceptives interfere with your body's natural cycle. The most definitive method for those on combined hormonal contraception is a temporary pause under medical supervision to allow your natural cycle to reveal itself. By discussing your unique situation, age, and health history with a healthcare provider, you can determine the best and safest approach for confirming your menopausal status while ensuring you remain protected from unintended pregnancy.
The Menopause Society is an authoritative resource for further information and guidance regarding menopause.
