What Happens If You Take Birth Control During Menopause?

Menopause is officially confirmed after a woman goes 12 consecutive months without a period. Navigating the hormonal shifts of the preceding phase, perimenopause, can be challenging, leading some to wonder what happens if you take birth control during menopause. While hormonal birth control does not delay menopause, it can have significant effects on managing symptoms and assessing your body's transition.

Quick Summary

Taking hormonal birth control during perimenopause can alleviate symptoms like hot flashes and irregular bleeding, but it also masks the natural hormonal fluctuations, making it difficult to determine when menopause is complete. Continuing combination birth control can increase health risks, such as blood clots, especially in women over 35 who smoke or have other risk factors.

Key Points

• Masks Menopause Signs: Hormonal birth control can mask the symptoms of perimenopause, making it hard to know when you've officially reached menopause.

• Manages Perimenopause Symptoms: Taking birth control can help regulate irregular periods, reduce hot flashes, and stabilize mood swings during the menopausal transition.

• Increased Health Risks: For women over 35 with certain risk factors (smoking, high blood pressure), combined hormonal birth control can increase the risk of blood clots, heart attack, and stroke.

• Requires Different Therapy After Menopause: Birth control is not a substitute for hormone replacement therapy (HRT); HRT uses lower doses tailored for symptom relief, while birth control contains higher doses to prevent pregnancy.

• Plan the Transition: Talk with a healthcare provider about a plan to transition off birth control, potentially including a trial period and testing, to determine if you are postmenopausal.

Understanding the Menopause Transition

Perimenopause is the transitional phase that precedes menopause, characterized by fluctuating hormone levels. Menopause officially marks the point when you have gone 12 months without a menstrual period, and your ovaries stop releasing eggs. The average age for menopause in the U.S. is 51, though perimenopause can begin years earlier. During this time, the hormonal changes can cause symptoms such as irregular periods, hot flashes, night sweats, and mood swings.

Can You Take Birth Control During the Menopause Transition?

Yes, in many cases, it is safe to take birth control during the perimenopausal phase, and it can offer significant benefits for symptom management. However, consulting a healthcare provider is crucial to assess your individual risk factors. Low-dose birth control pills are often prescribed to perimenopausal women to manage symptoms while also providing contraception.

Benefits of Taking Birth Control During Perimenopause

• Regulates Irregular Periods: The controlled hormones in birth control can stabilize the erratic periods common during perimenopause, reducing unpredictable bleeding and heavy flow.
• Reduces Hot Flashes: The synthetic estrogen in combined hormonal contraceptives can help mitigate the severity and frequency of hot flashes and night sweats.
• Stabilizes Mood Swings: By providing a consistent level of hormones, birth control can help smooth out the mood fluctuations caused by hormonal imbalances.
• Protects Bone Health: The estrogen in combination pills helps protect against the bone density loss that can increase the risk of osteoporosis during this transition.
• Prevents Unintended Pregnancy: While fertility declines with age, it is not zero during perimenopause, and birth control provides effective contraception.

The Masking Effect of Birth Control

One of the main side effects of using hormonal birth control during perimenopause is that it can effectively conceal the signs of your body's natural transition. Because hormonal contraceptives regulate your cycle and symptoms, you might not realize that your body's own hormone production is tapering off. This makes it difficult to pinpoint when you've officially entered menopause. Once you stop taking birth control, your true menopausal status will become clear.

Risks of Taking Birth Control During Perimenopause and Menopause

While beneficial for many, hormonal birth control is not without risks, and these can increase with age, especially after 35.

• Increased Cardiovascular Risk: For women over 35 who smoke or have conditions like high blood pressure, diabetes, or a history of blood clots, estrogen-containing birth control can increase the risk of serious cardiovascular events, including heart attack and stroke.
• Difficulty Assessing Menopause Status: As mentioned, the regulated bleeding and symptom control can hide the natural cessation of periods, making it hard for you and your doctor to determine when menopause is complete.
• Not a Substitute for Hormone Replacement Therapy (HRT): Birth control pills contain higher doses of hormones meant to suppress ovulation, unlike the lower, tailored doses in HRT designed specifically for managing menopause symptoms. Using birth control as a long-term substitute for HRT can lead to unnecessary risks.

Comparison: Birth Control vs. Hormone Replacement Therapy (HRT)

Feature	Hormonal Birth Control	Hormone Replacement Therapy (HRT)
Primary Goal	Prevents pregnancy	Manages menopausal symptoms
Hormone Dosage	Higher, to suppress ovulation	Lower, tailored for symptom relief
Provides Contraception	Yes	No
Use During Perimenopause	Can be used, especially to regulate irregular cycles	Often used when pregnancy risk is low and symptom relief is primary goal
Use During Menopause	Not typically used; HRT is preferred	Standard treatment for severe symptoms
Can It Mask Menopause?	Yes, by regulating bleeding and symptoms	No, it is used to treat identified menopausal symptoms

How to Transition Off Birth Control and Towards HRT

If you have been on hormonal contraception through your perimenopausal years and are approaching the average menopausal age, your doctor may suggest stopping or transitioning to another therapy. This typically involves a monitored period without hormonal contraception to allow your body's natural hormonal patterns to emerge.

1. Doctor Consultation: The first step is to speak with your healthcare provider about your options. They will assess your age, health history, and remaining symptoms to guide the transition.
2. Trial Period Off Hormonal Contraception: Your doctor may recommend stopping the pill or removing a hormonal IUD for a few months to see if your periods return naturally. During this time, a non-hormonal barrier method like condoms should be used if contraception is still needed.
3. Hormone Level Testing: Blood tests for follicle-stimulating hormone (FSH) can help confirm menopausal status after stopping hormonal birth control. Elevated FSH levels can indicate that menopause has occurred.
4. Consider HRT: If you have severe menopausal symptoms after stopping birth control, your provider may discuss transitioning to HRT, which uses lower hormone doses designed for symptom management rather than contraception.

Conclusion

Taking birth control during the perimenopausal phase can offer a range of benefits, from preventing unwanted pregnancy to managing bothersome symptoms like irregular bleeding and hot flashes. However, it comes with the trade-off of masking your body's natural progression towards menopause. For women over 35, especially those with certain health conditions, combined hormonal birth control carries increased risks, making regular consultations with a healthcare provider essential. As you approach the average age of menopause, discussing a transition plan from birth control to potentially lower-dose HRT is crucial for maintaining both comfort and overall health. The right approach is personalized and should be guided by a medical professional based on your unique health profile and needs.

Final Recommendations

• Consult a specialist: Discuss your situation with an OB-GYN or a women's health expert to determine the best course of action.
• Monitor your health: Pay close attention to any changes in your body and report them to your doctor.
• Weigh the pros and cons: Consider the benefits of symptom control versus the risk of masking menopause and potential health risks.

Frequently Asked Questions

Can taking birth control during perimenopause delay menopause?

No, taking hormonal birth control does not delay the onset of menopause. Menopause is a natural biological process, and contraception only masks the symptoms and the gradual decline of your own hormone production.

How can I tell if I've reached menopause while on birth control?

To confirm if you've entered menopause, your healthcare provider will likely have you temporarily stop hormonal birth control. After a few months, blood tests for follicle-stimulating hormone (FSH) can help assess your menopausal status. Menopause is officially confirmed after 12 consecutive months without a period.

Is it safe to take hormonal birth control over age 50?

It may be safe for some, but risks increase with age, especially for smokers or those with high blood pressure or a history of blood clots. A healthcare provider should assess your individual health profile to determine if continuing is appropriate or if a transition to another therapy is needed.

What is the difference between birth control and hormone replacement therapy (HRT)?

Birth control contains higher hormone doses primarily to prevent pregnancy, while HRT uses lower, tailored doses to manage menopausal symptoms. Birth control is not an appropriate substitute for HRT.

Can hormonal IUDs be used during perimenopause?

Yes, hormonal IUDs can be a good option during perimenopause, especially the levonorgestrel-releasing type. They can provide effective contraception and help manage heavy menstrual bleeding, a common perimenopausal symptom.

If I can’t take estrogen, what are my options for managing perimenopause symptoms?

If you cannot use estrogen-containing methods, progestin-only birth control pills or hormonal IUDs can be options. They can help with irregular bleeding, although they may not be as effective for hot flashes. Barrier methods like condoms are also available and don't involve hormones.

Why would my doctor prescribe birth control for menopause symptoms?

During perimenopause, low-dose birth control can regulate the significant hormone fluctuations that cause symptoms like irregular bleeding, hot flashes, and mood swings. It can offer a bridge to menopause by stabilizing these symptoms.