Menopause and Birth Control
Q:I am rapidly approaching my 50th birthday and thinking about menopause. But I am taking birth control pills. My understanding is that as long as I take the pills, I will keep having a period.
How will I know if I have reached menopause and no longer need a birth control method, if I keep having a period every month? (Not to mention exposing myself to any health risks of the pill unnecessarily.)
A:During menopause a woman’s body produces less of the hormones estrogen and progesterone. This often happens between the ages of 45 and 55 years old. A woman has reached menopause when she has not had a period for 12 months in a row and there are no other causes for this change. Every woman’s period will stop at menopause.
Perimenopause is the time leading up to menopause. It is during perimenopause that your body slowly starts making less estrogen and progesterone, and you begin to lose the ability to become pregnant. Some women have symptoms during this time that can be difficult, including changes in the menstrual cycle, hot flashes, night sweats, vaginal dryness, sleep problems, mood changes, and problems with concentration and memory.
Perimenopause can start as early as age 35. It can last just a few months or a few years. There is no way to tell in advance how long it will last or how long it will take you to go through it.
The oral contraceptive pill often prolongs the occurrence of regular menstrual periods, and even when you are frankly postmenopausal (when your ovaries sharply reduce production of female hormones), your periods may not stop when you are taking the pill. Without the pill, the average age of menopause is 51 years; about 90% of women have completed menopause by age 56.
And, you’re right, you wouldn’t want to take any medication if you don’t need to. Oral contraceptives do have increased risks (although still small) of heart attacks and strokes, particularly in women of older ages.
How to solve this dilemma? I usually discuss these issues with my 50-year-old patients and depending on their wishes, I recommend a trial off the pill for a month or two every year after age 50. You would need to use another contraceptive method, like condoms, during this time.
I then check a hormone level (follicle stimulating hormone, or FSH) and if it’s high enough, I check it again about six weeks later. If you do not bleed and you do not have hot flashes, and the two tests both show menopause, then you are probably postmenopausal and don’t need the pill.