Birth control for perimenopause

If you’re a woman in your 40s, you may have already noticed the changes. Maybe you’re dealing with hot flashes. Or your periods are a bit irregular. Welcome to perimenopause. During this transition into full-blown menopause, your levels of estrogen (one of the main female hormones) rise and fall rapidly.

So do you still need to use birth control? The short answer is yes, absolutely. But you might want to consider switching your method. Here’s why — and what you need to know to make that decision.

Benefits of hormonal birth control during perimenopause

Perimenopause can last 4 to 8 years, according to the Cleveland Clinic. It’s important to continue using some form of birth control during perimenopause because you can still get pregnant.

Hormonal birth control methods are one option. These include:

• Pill
• Patch
• Ring
• Intrauterine device (IUD)

As a perk, hormonal birth control can help ease symptoms of perimenopause. “Taking birth control with estrogen can reduce hot flashes and perhaps control premenstrual syndrome, or PMS,” says Maureen Whelihan, MD. She’s a gynecologist and sexual medicine practitioner in Lake Worth, Florida. “It’s a terrific way to transition into menopause.”

(FYI: Find out how to get your birth control online, step-by-step.)

Hormonal birth control may also reduce the risk of certain cancers. According to the National Cancer Institute, women who take the pill have a lower risk of these cancers:

• 30% lower risk of endometrial cancer
• 30% to 50% lower risk of ovarian cancer
• 15% to 20% lower risk of colorectal cancer

When a change in birth control makes sense

It’s a good idea to visit your gynecologist to discuss birth control options when you enter perimenopause, says Lisa Masterson, MD. She’s an OB-GYN in Santa Monica, California. Your doctor can help you figure out if your current method still fits your needs and sex habits.

If you’re a healthy nonsmoker, there is probably no need to change your birth control as you move toward menopause, Dr. Whelihan says.

However, you should not take birth control with estrogen if you’re a smoker over the age of 35 or if you have the following conditions:

• Heart disease
• Diabetes
• Blood clots in the legs
• High blood pressure (hypertension)

That’s because estrogen can thicken the blood, which can increase the risk of blood clots in some women. “A progestin-only birth control pill, shot, progestin-containing IUD or [the implant] may be safer alternatives,” Dr. Whelihan says.

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Factoring in family history

Do you have a family history of breast cancer? You may want to avoid hormonal birth control altogether during perimenopause.

“Women face a higher risk of breast cancer, ovarian cancer and uterine cancer once they reach menopause,” says Monique Brotman, DO. She is an OB-GYN in Oak Park, Illinois. That’s because these types of cancers rely on estrogen and progesterone to grow, so using hormonal birth control can further increase the risk.

Consider nonhormonal birth control methods instead. These include:

• Male condoms
• Female condoms
• Copper IUDs
• Phexxi^® contraceptive gel
• Spermicide
• Diaphragms
• Cervical caps
• Sponges
• Tubal ligation
• Vasectomy

The downside: Many of these methods don’t help with the symptoms of perimenopause, Dr. Whelihan says. They also don’t make your periods more regular.

Other ways to manage perimenopause symptoms

If hormonal birth control isn’t a good fit for you, there are other ways to keep perimenopause symptoms at bay. These include:

• Over-the-counter vaginal lubricants. Vaginal dryness is an issue at this age. A water-based lubricant can help make sex more comfortable.
   
• Phytoestrogens. These are estrogens in certain foods that may help with symptoms such as hot flashes, Dr. Brotman says. They’re worth a try. You can find them in soybeans, flaxseed, whole grains, apples, carrots and more.
   
• Exercise. Regular physical activity improves mood and sleep. Aim to exercise for 30 minutes or more on most days of the week.
   
• Black cohosh. Some women take this herb for hot-flash relief. But you should definitely talk to your doctor before taking any herbal or dietary supplements for perimenopause symptoms.

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Additional sources
Duration: Cleveland Clinic (2021). “Perimenopause”
Birth control and cancer: National Cancer Institute (2018). “Oral Contraceptives and Cancer Risk”