Birth Control for Perimenopause

“My gynee suggested I go on the pill to keep my cycle moving and to compensate for the lack of hormones. What’s your take?” was a question I received from someone on instagram.

It's not a short answer. My face on the picture for this post says it all. 

How does birth control “regulate hormones”?

The pill works by stopping communication from the brain to the ovaries. Basically, it shuts down your natural hormones - far from balancing them. The monthly “withdrawal bleed” is because of hormone withdrawal from the placebo pills, not a natural post ovulation bleed.

Birth control is often the recommendation for irregular period symptoms & perimenopause symptoms. Why? 

If you’ve got a few of these symptoms: poor sleep, anxiety, mood issues, PMS, brain fog, memory issues, vaginal dryness, headaches, heavy periods, hot flashes, or water retention, PCOS, and endometriosis, birth control is a seemingly one-size-fits-all approach that indeed can improve these symptoms.

That is the most common route to take, especially because it’s also a method that prevents unwanted pregnancies, and makes periods predictable.

I wish that solution came without risks. 

I also wish that it addressed the root cause of many hormonal symptoms. 

Irregular periods are a window to deeper root causes that the pill often masks. This is especially true for all of the years leading up to perimenopause. 

Once a woman hits perimenopause, starting as early as 35, declining hormones are natural phenomena. Stress, poor diet, lack of movement and sleep exacerbate these. 

In any case, the hormone levels often decline to such low levels that create greater health risks and heavy symptoms for a woman. Birth control reduces some symptoms, but creates other risks, especially because it is synthetic and oral.

Synthetic hormones have more risks than what’s naturally made in the body (aka bioidentical hormones). 

Oral hormones are at much higher dosages than topical hormones, because when taken orally, they have to go through the liver. 

See the below for the types of things that can happen with oral birth control.

Oral Birth Control Risks & Knock on Effects*

• When taken orally, the dosage has to be very high, even for a mini pill, because the liver has to metabolize it first before it gets absorbed. 
• Oral birth control is synthetic. Progestin is a synthetic progesterone, which can be taken orally or released in an IUD. It increases our risk of dementia, heart disease, stroke, breast cancer, and blood clots (especially as you age), while progesterone has the opposite effect. 
• Thyroid disturbance & increases risk for a number of autoimmune diseases
• hormonal alterations increase CRP (inflammation marker), compromising the immune system
• excess estrogen in proportion to progesterone is involved in thyroid hormone imbalance
• Weight changes, water retention
• Increased diabetes risk
• Increases blood pressure
• Nutrient depletion, especially in magnesium, B vitamins, zinc, and antioxidants.
• Depression 
•  2016 JAMA study of more than a million women between 15-34 years old, were 23% more likely to be prescribed antidepressants after starting birth control (the study was followed for 13 years)
• It disrupts the gut microbiome and vaginal flora, causing leaky gut and yeast infections. This also leads to estrogen dominance issues e.g. cysts, weight gain, irritability, because a healthy gut helps to metabolize estrogens well.
• Fertility issues after stopping the pill
• Note, the pill is often known to help with acne, headaches, mood, hair growth, but for some it gets worse. For example, synthetic progesterone (progestins) can create effects in the body that can cause acne, hair loss and depression. 

With that said, the pill is beneficial post endometriosis surgery or for alleviating certain symptoms while the person is working on diet and lifestyle factors. It also still may be chosen as the preferred birth control method.

If you’ve been on birth control for a while, and would like to come off, there is a detox period that the body needs to go through. Ensure you get the right support as you’re doing so.

*For those on IUD, much of the above applies if your IUD has synthetic progestins e.g. Mirena.

My recommended route for most peri-menopausal women:

As per a meta analysis (summary of several studies) from the NIH, it’s been proven that bioidentical hormones have lower risks of breast cancer and cardiovascular disease than the synthetic versions. Therefore, bioidentical hormones are the preferred method of hormone replacement therapy across several countries’ health recommendations. Plus,these are naturally made in the body. 

I’ve been trained with the Menopause Method, which helps women know if they’re a good candidate to take bioidentical hormones, the right customized dosage for each person, and other needed support. I partner with your doctor in supporting you for this. Some bioidentical hormones are available in Mauritius. 

If someone is suffering with a combination of the below symptoms that indicate a progesterone and/or estrogen deficiency, and they are 35 and older, they’ll often see complete relief in just a few days with the bioidentical hormones. It's my suggested route for many as it not only relieves symptoms but improves health & longevity vs. not taking them, or vs. taking synthetic. 

• Poor sleep
• Anxiety
• Mood issues
• PMS
• Brain fog
• Vaginal dryness
• Headaches
• Heavy periods
• Hot flashes, or water retention, PCOS, and endometriosis,

Evaluation is recommended prior to starting, in order to get a robust picture of your health to ensure it’s the right fit.

With all of that said, bioidentical hormones are not a one-size-fits-all approach either, but definitely an option that’s worth exploring for you, if you’d like less side effects, complications and risks than oral birth control or no treatment. For some, oral birth control in conjunction with bioidentical hormones is the chosen route. It just depends on the individual's health and desires.

Would you like more hormone info?

Dr. Karen Hartzenberg and I are doing a trial community online forum to support women in perimenopause and menopause, starting in January 2024. If you’d like to be invited to a free online series of discussions, pop your details here to join and/or contact me at [email protected] for private coaching. 

To your heart & health span,

 Lindsay