Birth Control and Perimenopause

If you’re of a certain age and experiencing irregular periods, hot flashes, and insomnia there’s a good chance you’ve entered perimenopause, the time leading up to menopause. How long perimenopause lasts, and how severe symptoms like sleepless, sweaty nights are, varies by person.

For women who take birth control pills, however, the signs of perimenopause might not be so obvious. This is because the hormones in birth control can mask perimenopause symptoms.

After all, as long as periods continue, even sporadically, pregnancy is still possible. Contraception is important for these women. But is birth control necessary and safe during perimenopause?

Knowing the Symptoms of Perimenopause

Before answering that question, first it’s important to define perimenopause. Marked by a reduction in estrogen and progesterone, perimenopause is the transitional time before menopause. It’s not until a woman has been without a menstrual cycle for one year that she has officially entered menopause.

On average, perimenopause lasts four years, and the average woman enters menopause at age 51. However, these ranges can vary widely. Perimenopause can begin during a woman’s early 40s or even sooner.

One of the most important steps in navigating the changes perimenopause brings is to know the common symptoms, which include:

• Irregular periods

• Hot flashes

• Insomnia or other sleep problems

• Night sweats

• Decreased libido

• Mood swings

• Appetite changes

• Vaginal dryness

Taking Birth Control Pills During Perimenopause

The most common birth control pills contain a combination of synthetic estrogen and progesterone, the hormones responsible for a woman’s menstrual cycle. At the onset of perimenopause, estrogen and progesterone levels decline, usually bringing on the symptoms mentioned above.

However, since combination birth control pills release estrogen and progesterone into the body, women who take them may not have perimenopause symptoms. Some women still experience them, but to a lesser degree, and others may notice the signs only when they take the inactive pills.

Determining if You Are in Perimenopause

Unlike pregnancy, there is no test you can take to definitively tell you if have reached perimenopause. If you observe perimenopausal symptoms while taking the placebo pills in your birth control pack, this is often a good indicator that your body is in perimenopause.

Some women who are using birth control choose to stop taking the pills because they want to let the body’s natural hormones take over, possibly giving them a more conclusive answer. If symptoms persist, you are likely in perimenopause. If, after halting the birth control, the symptoms disappear, they could have been side effects of the medication, meaning you are not in perimenopause.

It may take anywhere from four weeks to several months for the body and its hormones to regulate after you have ceased taking birth control. There is also a possibility that you have already reached menopause, and menstruation might not be present at all.

Continuing Birth Control Pills to Manage Perimenopause Symptoms

Taking birth control during perimenopause has several benefits. Doing so keeps hormone levels consistent, reducing the fluctuations that produce perimenopause symptoms, many of which can significantly and negatively impact women’s lives. 

The obvious benefit is contraception, and it is necessary for many women experiencing perimenopause. In fact, in the United States, women in their 40s have the second highest rate of unintended pregnancy (teens have the highest). In addition, birth control pills can protect perimenopausal women from ovarian and uterine cancers, while also helping to prevent bone loss that can lead to osteoporosis.

In general, birth control is safe for nonsmoking women who are older than 35, as most perimenopausal women are, and who do not have a history of any of the following:

• High blood pressure

• Estrogen-dependent cancer

• Heart disease

• Diabetes

• Blood clots

Choosing the Right Birth Control During Perimenopause

If perimenopause causes a natural reduction in estrogen and progesterone levels, how do you know which birth control medication is best for your body?

Most of the time, perimenopausal women will benefit from a combination birth control method, meaning one containing both estrogen and progesterone. Combination pills are the most common. The other type of birth control is the progestin-only pill, sometimes called the mini pill. This is not usually recommended for perimenopausal women because it does not replace the body’s naturally declining estrogen.

Narrowing down the choices, many health experts recommend low-dose birth control pills for women in perimenopause. The reduced amount of estrogen, specifically 20 micrograms or less, is considered safer for women as they approach menopause. Companies like Nurx provides access to several low-dose combination birth control options. They all have 20 micrograms of Ethinyl estradiol, which is the synthetic version of estrogen. The exceptions are Lo Loestrin FE and Nuva Ring, containing 10 and 15 micrograms, respectively.

As with all medications, each drug has side effects. In general, side effects of birth control include breakthrough bleeding, nausea, breast tenderness, headaches, weight gain, mood swings, decreased libido, and vaginal discharge changes.

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