Hormonal Birth Control in Perimenopause: How and Why It’s Used

Hormonal birth control in perimenopause, containing estrogen delivered through pills, patches, or vaginal rings, can play a role in managing the menopause transition for women under age 55.

Understanding the Menstrual Cycle and Hormones

To understand how HBCs work, let's review the menstrual cycle and the role of hormones. During a normal menstrual cycle, two hormones, follicle-stimulating hormone (FSH) and luteinizing hormone (LH), both released by the pituitary gland in the brain, manage the development of the egg, ovulation, and preparation of the uterus for implantation. HBCs containing estrogen and a progestin suppress FSH and LH, disrupting the process so that ovulation does not occur. Progestin also thins the uterine lining, decreasing monthly bleeding.

Why Hormonal Birth Control Can Help During Perimenopause

During peri-menopause, hormonal fluctuations can be erratic, making it challenging to manage symptoms. By suppressing FSH and LH, HBCs prevent ovulation and stabilize estrogen levels, effectively managing symptoms associated with peri-menopause.

Managing Bleeding, Mood, and Contraception

In addition to stabilizing estrogen levels, HBCs can address other menopausal symptoms:

• Contraception: Although the chances of getting pregnant decrease significantly after age 45, contraception is recommended until age 55 or one year after the final period, whichever comes first.

• Mood Disorders: HBCs can help manage mood disorders, which may appear or worsen during the menopause transition.

• Bleeding Issues: HBCs also are effective in managing irregular or heavy periods common during peri-menopause by suppressing ovulation and thinning the endometrium.

If the primary symptom of peri-menopause is irregular and/or heavy bleeding, a levonorgestrel IUD may be a good option. However, an IUD may not be suitable for everyone, (e.g., women with large fibroids.) Women who have been taking HBC for years prior to peri-menopause who have no new symptoms can continue using it until the average age of menopause (~52 years old). By age 55, women should transition to MHT or discontinue hormone use altogether if they no longer have unwanted symptoms. Talk with your doctor about whether MHT or other invention can best help with your menopause symptoms.

Hormonal Birth Control in Perimenopause vs Menopause Hormone Therapy

I get a lot of questions about why I prescribe HBCs during peri-menopause but switch to MHT once menopause has commenced. I get the confusion - both contain estrogen and a progestin. Here's the short answer: the progestins in MHT and HBCs are not the same, and, the estrogens also are different. The primary purpose of HBC is to prevent pregnancy. The HBCs are developed and tested for that purpose, using reproductive age women as the target audience.

Why Treatment Changes After Menopause

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