Perimenopause And Birth Control

Introduction

If you're experiencing signs of perimenopause like irregular periods, mood swings, or hot flashes, you're not alone. The transition into perimenopause can begin anywhere from your mid-30s to mid-50s. This transitional phase before menopause can be confusing and uncomfortable during which levels of oestrogen decrease. When you have 12 consecutive months without menstruation, you may have entered into menopause.¹

Understanding and managing perimenopause is crucial for maintaining your well-being during this time of change. In this article, we'll explore the complexity of perimenopause and explore the important topic of birth control options for someone in this stage of life.

Whether you're seeking clarity on your symptoms or looking for guidance on managing your reproductive health, this article aims to provide valuable insights tailored to your needs. Let's navigate perimenopause together.

What is perimenopause and why it happens?

Perimenopause is a natural stage that women/persons assigned female at birth (AFAB) go through before reaching menopause, usually happening in the years just before menopause starts. This transition typically begins in your 40s, although it can happen anywhere from your mid-30s to mid-50s.

The underlying cause of perimenopause is the gradual decline in ovarian function.² As you enter perimenopause, your ovaries start producing less oestrogen and prepare to stop releasing eggs entirely. This decline disrupts your menstrual cycle, leading to irregularity and eventually, its disappearance altogether (menopause) when you lose the ability to get pregnant. This hormonal shift can lead to a variety of symptoms you might be experiencing.³

Symptoms during perimenopause include:

• Irregular periods (more, fewer, heavier, lighter)
• Hot flashes and night sweats (sudden feelings of hot or cold)
• Mood swings or anxiety
• Vaginal dryness
• Decreased sex drive
• Sleep issue
• Muscle aches and joint pains
• Tiredness

These are the most common symptoms and many experience either of these. However, the duration of symptoms may vary in different individuals. This section just provides a starting point, and the rest of the article will explore how birth control can help manage these symptoms effectively.

How can birth control help manage your symptoms? 

Birth control used during perimenopause can fulfil two objectives:

1. It helps prevent pregnancy for those who aren't yet in menopause but want to avoid getting pregnant
2. It can also ease symptoms for those who prefer not to use hormone replacement therapy (HRT)⁴

As menopause gets closer, oestrogen levels drop, but this decline isn't steady because oestrogen levels fluctuate a lot during perimenopause. Birth control pills have artificial hormones that hide this natural decrease in hormone levels before menopause. So, birth control pills might ease certain symptoms of perimenopause.

Birth control options during perimenopause

You can have a variety of alternatives for birth control during perimenopause. You may choose any of these alternatives after seeking expert medical advice depending on your personal preferences and medical history. Birth control methods for perimenopause include hormonal and nonhormonal methods.

Hormonal methods

Here is a list of hormonal methods:⁵

• Birth control pills
• Patches
• Vaginal ring
• Intrauterine devices (IUDs) contain progestin (a synthetic version of the hormone progesterone found naturally in the body)
• Implants

During perimenopause, birth control pills can help to balance hormones. There are two main types:

1. Combination pills: These contain both oestrogen and progestin in one pill. They're usually taken for 28 days, but some are taken continuously for four months.
2. Mini pills: These only contain progestin and are often used by breastfeeding mothers.

Whether combination or mini pills, they work differently. Combination pills thin the uterus lining, thicken cervical mucus, prevent ovulation, and block sperm from fertilising an egg.

Mini pills, without oestrogen, mainly thin the uterus lining, thicken cervical mucus and prevent egg release.

Hormonal birth control utilises hormones to either prevent ovulation or alter conditions within the uterus or cervix.⁶

Benefits of hormonal methods

• Help to regulate irregular periods
• Ease common perimenopausal symptoms
• Prevention of unintended pregnancy
• Helps to stabilise hormone levels, reducing the intensity of perimenopausal symptoms
• Protection against certain health conditions such as combined oral contraceptives offers protection from ovarian cysts, endometrial cancer, and pelvic inflammatory disease

Overall, hormonal birth control can provide those in perimenopause with relief from symptoms and greater control over their reproductive health.

Risk of hormonal methods

While hormonal birth control methods have benefits, they also pose risks such as higher chances of:⁷

• Breast cancer
• Developing blood clots
• Heart attacks
• Stroke

Non-hormonal methods

Here is a list of non-hormonal or barrier methods:

• Condoms
• Diaphragms
• Cervical cap
• Sponge
• Spermicide or contraceptive gels

Non-hormonal or barrier methods of birth control work by physically blocking or killing sperm, preventing them from fertilising an egg. Some people like these methods because they don't mess with your hormones, so they won't hide any symptoms you might have during perimenopause.

FAQs

Do birth control pills help with perimenopause?

Birth control pills can help reduce various symptoms commonly experienced during perimenopause, like irregular periods, menstrual cramps, heavy bleeding, and hot flashes.

When should I stop taking contraception during perimenopause?

One should typically keep using contraception until they reach menopause which happens typically around 50 to 55 years of age.

What is the average age to start perimenopause?

Perimenopause, a phase before menopause, usually starts a few years before one’s last period. This transition can begin early for some in their 30s, but it's more common between ages 40 to 44.

Does staying on the pill delay menopause?

Whether you're on birth control pills or not, menopause typically happens around age 50. However, since birth control pills use hormones to mimic a regular cycle, they might hide the signs of perimenopause and menopause.

Summary

Perimenopause is a natural phase before menopause, typically starting in the 40s but can occur as early as the mid-30s or as late as the mid-50s. It's marked by hormonal changes leading to symptoms like irregular periods, hot flashes, vaginal dryness, mood swings, and more. Birth control methods, including hormonal options like pills, patches, and IUDs, can help manage symptoms and prevent pregnancy during this phase. 

Hormonal birth control regulates periods, eases symptoms, and offers protection against certain health conditions. Non-hormonal methods like condoms and diaphragms are also available for those who prefer them. One should typically continue using contraception until menopause, which usually occurs around age 50. Whether or not using birth control pills, menopause typically happens around the same age, but pills may mask perimenopausal symptoms. Make sure you consult with your doctor to know if birth control is right for you during this phase of perimenopause.