Women in their late 30s and early 40s are often dismissed as “too young” for perimenopause. Healthcare providers aren’t asking the right questions, and women are left turning to friends, relatives, and social media for answers.
A recent New York Times article captured this phenomenon. One woman interviewed was a self-described “global wellness expert” who still couldn’t find help for her symptoms. She learned about a comprehensive hormonal practice only after a friend shared her story in a WhatsApp group chat.
This gap in care is real, and it’s why I want to discuss a treatment option that often helps perimenopausal women: low-dose birth control pills.
Perimenopause vs. Menopause: What’s the Difference?
Menopause has a strict definition: no period for 12 months.
Perimenopause is different. It’s not defined by a length of time, but by symptoms and signs that can start years before menopause officially begins.
This is where confusion sets in. Perimenopause often coincides with other life transitions: teenagers at home, career pressures, aging parents, etc. Sleep problems might stem from stress, hormonal shifts, or both.
Teasing apart these factors takes time and attention that a rushed appointment doesn’t allow.
How Low-Dose Birth Control Pills for Perimenopause Work
Low-dose oral contraceptives (low-dose birth control pills) stabilize hormone fluctuations. Combined oral contraceptives contain both estrogen and progesterone, and this combination:
- Reduces vasomotor symptoms like hot flashes
- Regularizes the menstrual cycle
- Decreases abnormal uterine bleeding
- Suppresses ovulation
- Stabilizes estrogen and progestin levels
The net effect is fewer of the hormonal swings that make perimenopause so disruptive.
Progestin-only low-dose birth control pills exist, and they do suppress ovulation. But they tend to be less effective at reducing vasomotor symptoms because they lack estrogen.
What Symptoms Does Birth Control for Perimenopause Address?
The two hormone components in combined oral contraceptives address different symptoms:
- Progestins help with sleep disturbances.
- Estrogen helps improve mood swings, hot flashes, and irregular bleeding.
Mood and sleep often improve within the first few weeks of taking low-dose birth control pills for perimenopause. Hot flashes may follow a similar timeline.
Irregular bleeding can take longer (sometimes two to three cycles) because low-dose birth control pills can cause spotting initially. This usually levels out after about three cycles.
Low-Dose Birth Control Pills vs. Menopause Hormone Therapy
Aren’t birth control pills and menopause hormone therapy (MHT) both “hormones”?
Yes, but they differ in important ways.
First, MHT uses much lower hormone doses than even low-dose birth control pills.
Second, birth control pills suppress ovulation. This matters for perimenopausal women who still need contraception and aren’t using another method.
Third, with MHT, we often cycle progesterone, meaning you take it only during certain days of the month. This requires remembering which days to take what.
Low-dose birth control for perimenopause is simpler: Take a pill every day from the packet, including the placebo pills, and you’re set.
Who Is a Good Candidate for Low-Dose Birth Control Pills for Perimenopause?
The ideal candidate for low-dose birth control pills for perimenopause is:
- Otherwise healthy
- A non-smoker
- Under 50 years old
- Without cardiovascular disease risk factors
- Not obese
- Without diabetes
- Without a history of migraine with aura
Who Should Avoid Low-Dose Birth Control for Perimenopause?
Low-dose birth control for perimenopause is not appropriate for everyone. Contraindications include:
- Smoking
- Migraine with aura
- Poorly controlled high blood pressure
- Known cardiovascular disease (history of heart attack, for example)
If any of these apply to you, other options exist. An individualized approach is always best.
Your First Step
Start by keeping a diary of your symptoms and how they relate to your menstrual cycle. Bring that information to your doctor.
Finding the right treatment fit sometimes involves trial and error, and that process takes time. But exploring these options can be helpful.
Today’s Takeaways
Don’t write off your symptoms as “just stress” or accept being told you’re “too young” for perimenopause. This phase of life has historically been underserved and dismissed in traditional healthcare.
At Banner Peak Health, that’s not our approach. If you’re experiencing symptoms that sound like perimenopause, bring that information to your next visit. Let’s discuss your options and figure out whether low-dose birth control for perimenopause works for you.
