Why Birth Control Pills Can Help With Perimenopause

If you’re currently coasting into the joys of middle age, you might think that the years of birth control pills are far behind you. But that’s not true for everyone — just ask the many perimenopausal women taking oral contraceptives for more than preventing unwanted pregnancies.

Experts agree that for some people, taking the pill can make perimenopause less unpleasant.

Why take birth control pills during perimenopause?

If you need a refresher, perimenopause is the time before menopause (usually in your 40s or early 50s) and extends to one year after the final menstrual period, when fertility declines, estrogen and progesterone levels decrease, and you may experience symptoms like irregular periods, hot flashes, mood changes, disturbed sleep and vaginal dryness.

So how exactly can birth control pills help with this transition?

Yes, birth control pills can prevent unwanted pregnancies, but they can also help decrease the variability in hormone levels that occurs during perimenopause when some menstrual cycles make an egg and others don’t.

Basically, when you do ovulate, you’re receiving high estrogen and progesterone, and then when you don’t ovulate during the next cycle, those values are low. This situation is like a roller coaster for your body and can cause hot flashes, heavy irregular periods, poor sleep, foggy brain, irritability and mood issues. That’s why birth control pills can be helpful: they stop ovulation and help maintain the appropriate estrogen and progesterone levels in your body.

The two most prevalent types of birth control pills that people take are:

Combination pills: These pills contain both estrogen and progestin in one pill and typically have a 28-day cycle (21-day active pill and 7-day placebo), though most people take them continuously during perimenopause to avoid bothersome periods and to minimize hormonal fluctuations. They work by inhibiting the secretion of certain hormones, therefore preventing ovulation and the release of an egg that can be fertilized. These pills vary in the amount of estrogen they contain and come in low-dose and ultra-low-dose versions (for people who are more sensitive to estrogen).

Mini pills: These pills only contain progestin and have no additional active components. They work by slowing an egg’s journey through the fallopian tubes, while also thickening cervical mucus and thinning the lining of the uterus. They can sometimes help prevent ovulation (though not as well as the combination pill).

Since the mini pills don’t contain any estrogen, they may alleviate some symptoms of perimenopause (like irregular or heavy bleeding) but not as well as a product that also contains estrogen, like combination pills. However, there are reasons why some people can’t take the combination pill option — which we’ll get into later.

How birth control can ease perimenopausal symptoms

When you begin experiencing the signs and symptoms of perimenopause, things can seem very overwhelming, and your body can feel completely out of whack, but that's where birth control pills can come to the rescue or at least offer some relief.

"Perimenopausal women may benefit from oral contraceptive pills,” says Emalee Danforth, certified nurse-midwife at the Complex Menopause Clinic within the Center for Reproductive Health and Fertility at UW Medical Center – Roosevelt. “They offer excellent control of bleeding timing and reduction in bleeding quantity, and there are many inexpensive options on the market.”

Danforth says she usually selects a low- or very-low-dose pill for her perimenopausal patients because it helps to minimize the side effects while still providing the benefits — bringing their hormones closer to the “just right” amount that they need.

There’s more good news: Aside from helping to regulate your periods and bleeding, birth control pills with some estrogen might do you some other favors, like:

Help with bone health. Estrogen may help prevent bone loss and protect you from osteoporosis, a disease when your bones become weak and prone to breakage.

Lower your risk of some cancers. Hormonal birth control suppresses ovarian function, decreasing your chances of ovarian cancer. It also can suppress endometrial cell growth, which reduces the risk of uterine cancer.

Improve acne and stop unwanted hair loss. Both of these tend to occur during perimenopause because of fluctuating hormones. Oh, and on the other end of the spectrum, they can help stop hair growth in unwanted areas of the body (no thank you, pokey chin hairs).

Birth control pills may also reduce hot flashes, decrease migraines, lower your chances of iron deficiency and anemia and generally help with PMS symptoms that often worsen during perimenopause.

Who shouldn't take birth control pills

Despite these perks, there are some folks who should avoid taking birth control pills with estrogen and progestin.

“For smokers, those with cholesterol problems, high blood pressure, obesity and other medical problems, standard dose oral combined contraception is not appropriate in perimenopause,” says Susan Reed, MD, MPH, MS, an OB-GYN at the Center for Reproductive Health and Fertility at UW Medical Center – Roosevelt.

The extra estrogen that birth control delivers may increase the risks of blood clots, heart attacks or stroke, especially in people who already have issues with obesity, type 2 diabetes or high blood pressure. This is why some folks might be better off taking a progestin-only form of birth control pill.

There’s also some research that suggests combination birth control increases your risk of breast cancer, but don’t panic — that seems to be a very rare occurrence. According to Reed, risks related to pregnancy in perimenopause are far greater than any risk of breast cancer.

How do you know you’re in menopause when taking the pill?

Another side effect of going on the pill during perimenopause is you might not know that you’ve hit menopause.

“Taking birth control pills will not delay menopause, but it will make it less clear when you have your final menstrual period,” says Danforth. "Eventually, when you stop or take a break from pills, you will see if your body has finished naturally menstruating.”

She explains that as patients age past the time when they’re more likely to have babies, they may wish to switch to a lower-dose hormone therapy option, then eventually taper off all hormones when the most symptomatic years of perimenopause have passed.

Reed explains that if you’re wondering about your menopausal status and want your healthcare team to look into it, they’ll generally check hormone values after 7 to 14 days of not taking birth control pills — though hormone values aren’t really a foolproof way to show if someone is postmenopausal or perimenopausal. Combining the results of the hormone test with your age helps predict your chance of pregnancy and when you will be postmenopausal.

Are there other forms of contraception that also prevent perimenopause symptoms?

There sure are. Reed suggests talking to your doctor about the progesterone IUD plus estrogen and the vaginal contraceptive ring. Also important to note, the contraceptive hormone patch is not recommended for perimenopause symptoms.

When hormone therapy (HT) is a better option

As mentioned earlier, at some point it might be easier to transition from taking birth control pills to diving into hormone therapy.

“Because hormone therapy has a lower dose of hormones, there are fewer medical restrictions on who can take it," says Danforth.

And therefore, fewer complications. However, it’s important to remember that hormone therapy is not birth control, so if it’s possible that you’re still fertile and having sex with men, make sure you’ve thought about how you’re going to keep the baby-making at bay.

And, obviously, your OB-GYN is going to be the best person to go to with all your questions. They can help you figure out the best approach for you based on your health history, needs and plans for the future. There isn’t a one-size-fits-all solution when it comes to handling perimenopause and its symptoms, but the more information and tools you have at the ready, the smoother it will go.