Menopause Mondays: Birth Control and Perimenopause

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You wake up in the middle of the night to sweat-soaked sheets, your thoughts are wading through brain fog, and you can’t remember the last time your period didn’t come as a (heavier-than-ever) surprise. Congratulations! You’re going through perimenopause.

Unless you want to add a baby into the mix—or for some reason love your perimenopause symptoms—you might want to consider your contraception options.

During women’s late 30s and 40s, they produce less progesterone, and their number and quality of follicles decrease which are the basic units of female reproductive biology. Cycle length and ovulation become irregular, with results ranging from surprise periods to surprise babies, according to Dr. Margery Gass, MD, NCMP, and Executive Director of The North American Menopause Society.

Since a woman’s fertility drops after age 30, many women in the throes of perimenopause believe they can’t and won’t get pregnant. This is not really the case, since less-than-regular cycles make it difficult for women to prevent pregnancy without the use of contraceptives. “Ovulation becomes unpredictable during perimenopause, so it is difficult for a woman to know when she is ovulating and can become pregnant,” Gass says.

Besides blocking babies, hormonal contraceptives—including pills, patches, shots, and implants,—can ease the pain of perimenopause. “Continuous hormonal contraceptives can eliminate hot flashes in perimenopausal women,” Gass says. “Mood may get better for some, but not all women.” Hormonal contraceptives can also reduce vaginal dryness and prevent bone loss, which are both common and potentially serious complications of perimenopause, she says. Also during their “change,” many women experience painful, heavy periods that can them leave wondering if they should buy stock in tampons and pads. However, by suppressing ovulation, birth control pills can quell heavy menstrual flow and regulate periods, according to Harvard Medical School.

Be careful, without correct supervision from a doctor, hormonal contraceptives can send you some mixed signals. “Hormonal contraceptives can induce menstrual-like bleeding for years. Generally women have to stop the pills to see if they are in menopause. After she has discontinued the pills for a month or more, she can check her FSH (follicle-stimulating hormone) level,” Gass says. Follicle-stimulating hormones control your menstrual cycle, your production of eggs, and can reveal whether or not you have entered menopause. Testing FSH a second time one month later will provide a more reliable result.

You should make special considerations when selecting a form of birth control. For example, while it is safe for women who smoke to use oral contraceptives until age 35 (however, we strongly advise against smoking), later the cardiovascular risk associated with birth control pills and smoking exceeds the (normal) risks associated with pregnancy, according to Gass. Hormonal contraception is typically prescribed at a higher dose than hormone replacement therapy, suggesting that hormonal contraception carries a higher risk of blood clots, strokes, and heart attacks. Also, for a woman who is at least 50 years old, having an IUD implanted may not make sense, since the cost and the protection are based on five years of use, Gass says.. Together with your physician you can decide when and if it is best to transition to hormone therapy.

Chances are you’ve spent 20+ years trying not to get pregnant—and you aren’t done yet! If you are in perimenopause, contraception is still an important piece to your health. It can spare you from diaper duty and hot flashes alike. Take control of your body. Talk to your doctor and find hormone happiness today.

Click here to download my free eBook, MENOPAUSE MONDAYS: The Girlfriend’s Guide to Surviving and Thriving During Perimenopause and Menopause.

Suffering in silence is OUT! Reaching out is IN! 


After struggling with her own severe menopause symptoms and doing years of research, Ellen resolved to share what she learned from experts and her own trial and error. Her goal was to replace the confusion, embarrassment, and symptoms millions of women go through–before, during, and after menopause–with the medically sound solutions she discovered. Her passion to become a “sister” and confidant to all women fueled Ellen’s first book, Shmirshky: the pursuit of hormone happiness. As a result of the overwhelming response from her burgeoning audiences and followers’ requests for empowering information they could trust, Ellen’s weekly blog, Menopause MondaysTM, was born.

  • As always thanks for the great information.

  • Ellen, this article is so true, and I’m living proof of it.

    • Ellen Dolgen

      Maritza, I love that!

  • Angele

    I have been experiencing some really bad depressive episodes. I feel out of control a lot lately. I have never apologized to my family as much as I have lately. Does getting on birth control help with these swings or should I see a shrink?

    • Ellen Dolgen

      Angele, I am so sorry you are going through so much. I would need a little more detail….email me directly at

  • Thanks for the helpful info!

  • Kim Cummings

    can i try a low dose of birth control before trying hormone replacements.
    Im 55yrs old, is to late?

    • This is a great question for your Menopause Specialist. There is no one-size-fits-all answer. Your menopause specialist will look at your entire health profile and be able to determine an individualized program that works for your health needs. If you don’t have one, you can get some tips here: