Using the Pill to Treat Menopause

While the main reason to take birth control pills is to prevent pregnancy, it turns out that the Pill can also act as a treatment for women approaching menopause — the time period called perimenopause — to manage irregular periods, hot flashes, and night sweats.

Birth control pills contain various combinations of the hormones estrogen and progesterone and are designed to shut down ovulation so that you don’t release a monthly egg and can’t get pregnant.

“As women age, the balance between the pituitary gland that excretes follicle stimulating hormone (FSH), and the ovary that excretes estrogen is all over the place,” says Robert S. Wool, MD, an ob-gyn at Noble Hospital, Mercy Medical Center, and Baystate Medical Center and in private practice in Westfield and Springfield, Mass. “Women may be making estrogen, but not usually cycling. Birth control pills will quiet the wildness of the reproductive cycle in a perimenopausal woman.”

It is important to note that, once you reach true menopause, you’ll stop taking the Pill — there’s no longer the need to suppress ovaries once they’re no longer active. If you’re still experiencing unpleasant symptoms, hormone replacement therapy, which uses smaller doses of hormones, might be an option, though you’ll want to discuss the risks with your doctor.

The Pill: Pros and Cons

Generally, birth control pills can bring relief for many perimenopausal women experiencing hot flashes or irregular periods, or both. If you and your doctor choose the birth control pill as a treatment for perimenopause, a low-dose type is best — usually 20 micrograms of ethinyl estradiol or less, but it may take some trial and error to find just the right dosage.

The Pill isn’t appropriate for every woman, however. “Women over age 35 who smoke are not good candidates to take birth control pills,” says Julia Schlam Edelman, MD, author of Menopause Matters: Your Guide to a Long and Healthy Life. “Smokers are at higher risk for getting a heart attack or stroke if they are over age 35 and take birth control pills.” Women with high blood pressure, who have had a blood clot in their leg, lung, or pelvis, who have had breast cancer, or who have liver disease also should not use birth control pills.

While the benefits of taking birth control pills may include relief of perimenopause symptoms like hot flashes and irregular cycles, there can also be the typical side effects of oral contraceptives, such as irregular bleeding (especially in the first few months), nausea, puffiness, and weight gain (though many low-dose oral contraceptive pills are weight neutral), says Charla Blacker, MD, a reproductive endocrinologist at Henry Ford Hospital in Detroit. “Mood swings usually are improved. However, occasionally, women report more depression with birth control pills. If a woman did not tolerate birth control pills during her early reproductive years, she may not tolerate them well in perimenopause.”

Also, women should be aware that birth control pills are not the fountain of youth. “Birth control pills can mask and treat symptoms,” says Dr. Wool, “but they do not alter the aging process.” Menopause will still occur when nature intends, although if a woman continues on perimenopausal birth control pills, she may not realize exactly when she has passed into menopause. In that situation, after stopping the pills, she will no longer menstruate and may begin to have hot flashes that were previously masked.

Ultimately, whether to use the Pill for perimenopause symptoms is a decision that should be made by you and your doctor. Each woman’s situation is different and there is no one-size-fits-all solution.