Perimenopause is the natural transition period leading up to menopause, characterized by significant and often unpredictable fluctuations in reproductive hormones like estrogen and progesterone. This phase commonly begins in a woman’s 40s, lasts several years, and often brings challenging physical and emotional changes. Birth control can absolutely be taken during perimenopause. Hormonal contraception is frequently recommended because it serves a dual function beyond simple pregnancy prevention.
The Dual Role of Birth Control in Perimenopause
The use of hormonal contraceptives during perimenopause addresses two distinct biological needs. First, while fertility declines with age, unintended pregnancy remains a concern because ovulation still occurs, albeit irregularly. Contraception is necessary until menopause—12 consecutive months without a period—is officially confirmed.
The second function is the management of perimenopausal symptoms. The synthetic hormones in birth control, particularly combined methods, provide a steady dose that counteracts the body’s erratic hormonal surges and drops. This stabilizing effect helps smooth out the hormonal fluctuations causing bothersome symptoms. By regulating hormone levels, these medications can significantly alleviate irregular or heavy menstrual bleeding, reduce hot flashes, and stabilize mood swings.
Recommended Hormonal and Non-Hormonal Options
For women without specific health contraindications, low-dose combined oral contraceptives (COCs), containing both estrogen and progestin, are often prescribed. COCs are highly effective for contraception and symptom relief because they suppress ovulation and provide comprehensive hormonal stabilization. Taking these pills continuously, without a placebo week, can minimize hormonal fluctuations and lead to lighter or absent periods.
When estrogen is medically inappropriate, progestin-only methods are preferred for contraception and managing heavy bleeding. These options include the progestin-only pill, contraceptive implants, and hormonal intrauterine devices (IUDs). Hormonal IUDs release progestin directly into the uterus, offering long-term, highly effective contraception. They are especially effective at reducing heavy menstrual flow, often causing periods to become very light or stop entirely. Non-hormonal barrier methods, such as condoms or diaphragms, and the copper IUD are also available for women who wish to avoid hormonal therapy.
Assessing Safety and Health Risks
As women age, the risk profile associated with certain types of birth control changes, necessitating careful medical evaluation. A primary consideration is the use of combined hormonal contraceptives (containing estrogen) in women over 35. The risk of serious cardiovascular events, such as venous thromboembolism (VTE), heart attack, and stroke, increases when estrogen is combined with specific risk factors.
These contraindications include smoking (especially over 35), existing hypertension, a history of blood clots, and migraines with aura. For individuals with these conditions, the risks of combined methods often outweigh the benefits, leading to a recommendation to switch. Progestin-only or non-hormonal options are safer alternatives because they do not carry the same cardiovascular risks. Age alone is not a reason to stop contraception, but it underscores the necessity of regular medical check-ups to assess developing health concerns.
Determining the End of Perimenopause
A unique challenge of using hormonal birth control is that it can mask the natural signs of menopause. Menopause is defined as 12 consecutive months without a menstrual period. However, the hormones in contraception can trigger a regular withdrawal bleed or suppress bleeding entirely, making it impossible to rely on a missed period to determine when the transition is complete.
Healthcare providers often rely on a woman’s age and clinical judgment, as the average age of menopause is approximately 51. One strategy involves stopping hormonal birth control, often around age 50, for two to three months to see if a natural menstrual cycle returns. Non-hormonal contraception must be used during this pause to prevent pregnancy. Blood tests measuring Follicle-Stimulating Hormone (FSH) levels can be used, but their accuracy is limited while synthetic hormones are being taken. Once menopause is confirmed, the focus shifts to deciding whether to begin a different regimen, such as lower-dose Hormone Replacement Therapy, for long-term health and symptom relief.