How do contraceptive pills affect (the symptoms of) menopause? A doctor explains!

If you are experiencing a regular monthly period, there's a very good chance that you are fertile. Therefore, many women, including perimenopausal women, use contraceptives to prevent getting pregnant. However, taking the pill can mask some of the symptoms of menopause, making it difficult for a person to tell if they have reached it. Dr. Jael Loefstop explains how this works, and what you need to know.Die Pille und die Wechseljahre

Contraceptive pills and menopause: what you need to know

The menopausal transition is a natural part of life during which the body changes and a woman’s reproductive life gradually ends. Most women reach menopause (their final menstrual period) around the age of 51. About 80 percent of menopausal women report having menopausal symptoms, such as hot flashes, mood swings and sleep problems, during this stage. Most of these symptoms are caused by hormonal changes.  

During perimenopause, the stage before menopause, it is possible to experience symptoms when you're still able to get pregnant. Therefore, many women use an oral contraceptive to protect themselves against pregnancy. However, in addition to preventing pregnancy, the contraceptive pill also has other effects on the body. For instance, it can mask the symptoms of menopause. 

Hormonal contraception and menopausal symptoms

Contraceptive pills contain high doses of synthetic hormones, usually ethinyl-estradiol (oestrogen) and/or progestin (progesterone). These hormones interfere with the natural hormonal balance in the body to suppress the menstrual cycle, preventing ovulation from taking place and potentially causing menopausal symptoms to be masked or reduced. As a result, women who would otherwise be having periods or symptoms due to hormonal fluctuations, might not experience any symptoms at all. 

Are you on the pill? Then you may not notice any period changes or other menopausal symptoms. This isn't necessarily a bad thing. Just know that it can happen. Whether you stay on the pill while transitioning through perimenopause is up to you. This choice depends on your personal preference and your situation. 

First things first. Do you still have periods and want to avoid getting pregnant? Then you need some form of birth control. Has it been 12 months since your last period? This means you are not fertile, so contraception is no longer needed. 

How do you know if you’ve reached menopause?

If you are on the pill (or any other form of hormonal contraception), you don’t know if you have reached menopause. You are probably still having monthly withdrawal bleeds in response to levels of synthetic hormones dropping (due to the break in your medication). 

The average age of a woman reaching menopause is around 51. Some doctors may recommend that you stop taking the pill around this age to see if your natural periods return. If you decide to come off the pill in consultation with your doctor, you still need to use some form of contraception because you may still be fertile. 

Long-term risks of contraceptive use

Using hormonal contraception after the age of 50 can raise your risk for certain health problems. It’s important to be aware of this. The longer contraceptives with synthetic hormones are used, the greater the risk of thrombosis, high blood pressure, cardiovascular disease and breast cancer.  

Hormonal birth control is usually safe for women in perimenopause. Do you smoke? Or do you have a family history of hormone-related cancer, high blood pressure, diabetes, blood clotting disorders or obesity? Then talk to your GP or a doctor about it. Another type of contraception may be better for you. 

HRT could be an option for you

Hormone replacement therapy (HRT) contains lower amounts of hormones than oral contraceptives. The main benefit of HRT is that it can help relieve most menopausal symptoms. Therefore, HRT may be a better option for you.

More about hormone therapy

What non-hormonal birth control alternatives are available?

Some doctors recommend coming off the pill and switching to a non-hormonal form of birth control. This is because the risks associated with oral contraceptives increase with age.  

What options are available for preventing pregnancy if you’re still having periods but cannot or don’t want to use hormones? 

• Condom: male condom or female condom. (Did you know that female condoms are three times stronger and thinner than latex condoms?) 
• Diaphragm (silicon cap) and spermicide gel: a diaphragm is a soft, silicone dome that covers the entrance to the uterus. It blocks sperm from reaching an egg. 
• Copper intrauterine device (IUD): once inserted into the vagina, a copper IUD can be left in for 5 to 10 years. 
• Sterilisation: tubal sterilisation in women (the fallopian tubes are tied or removed), vasectomy in men (the tubes that carry sperm are cut or sealed). 
• Temperature method: this method involves taking your temperature every morning and checking cervical secretions to predict ovulation. (If you know when you're ovulating, you know when not to have unprotected sex.) 

What options are available for menopause relief?

During perimenopause, fluctuating or declining levels of oestrogen and progesterone can cause hormones to become unbalanced, leading to symptoms such as menstrual changes, hot flashes and mood swings. Contraceptive pills suppress these symptoms. About 30 percent of menopausal women have severe symptoms that interfere with their daily life. So, on the one hand, lack of symptoms can be a blessing. On the other hand, it is good to know what options for menopause relief are out there, because the contraceptive pill is not always the best choice. One of these options is hormone replacement therapy (HRT). 

Contraceptive pills contain high doses of hormones to effectively protect against pregnancy. HRT also contains hormones, but in lower doses, sufficient to reduce menopausal symptoms. Therefore, for some women, using another form of contraception and combating symptoms with HRT can be a better option.  

Hormonal contraceptives can increase the risk of stroke and heart attack. A family history of hormone-related cancer, high blood pressure, diabetes, blood clotting disorders or obesity increases this risk. For this reason, some women are advised against using the pill. 

How to make an informed decision

Whether or not to use or continue using the contraceptive pill during perimenopause is something you need to discuss with your GP or a doctor. Every woman is different, so there is no one-size-fits-all approach.  

Talk to your doctor about your situation, the pros and cons, and alternative treatment options. Whatever option you choose, the main thing is to educate yourself about the options available to you and any associated risks. This way, you can make an informed decision that aligns with your well-being and personal needs. 

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