Many women enter perimenopause in their mid-40s, signaling the start of the transition to menopause — but what may come as a surprise is that pregnancy is still possible during this stage of life.
Throughout the menopause transition, women may experience irregular periods along with a variety of physical and emotional symptoms caused by hormonal changes. For women in perimenopause who use hormonal contraceptives to prevent pregnancy but also want relief from uncomfortable symptoms, can birth control meet both needs?
Rather than trying to do two jobs at once, hormonal birth control can help bridge the gap between women’s contraceptive needs during their reproductive years and the need for symptom relief during perimenopause, often in combination with hormone replacement therapy (HRT). That’s why it’s essential to understand the key differences between these two medications.
This article will explore the benefits and risks associated with birth control use during perimenopause and help women recognize when it’s time to make the jump to HRT, a treatment better suited for this phase of life.
How Birth Control Works for Perimenopause Symptoms
There are many forms of birth control, including oral contraceptives, intrauterine devices (IUDs), implants, patches, injections, vaginal rings, and condoms, among others.(1) Out of all these options, the method that doctors prescribe most in the United States is the combined birth control pill.(2) Therefore, this article will primarily focus on this form of contraception.
The combined pill, which contains estrogen and progestin, has two main functions: Estrogen helps regulate menstrual bleeding, while progesterone stops ovulation to prevent pregnancy.(2)
HRT also uses estrogen and progesterone to supplement hormone levels that fluctuate and gradually decline during the menopause transition. Treating perimenopausal symptoms is not the primary function of birth control pills. However, because they provide a steady stream of hormones similar to those in HRT, some women may find that combined birth control pills help relieve perimenopause symptoms too.
Beyond contraception, combined birth control pills may support women's health during perimenopause in the following ways:(3)(4)(5)
Regulating Periods: Birth control pills help maintain regular, predictable cycles of withdrawal bleeding, similar to a period. Bleeding also typically becomes lighter.
Reducing Hot Flashes & Night Sweats: The estrogen component in birth control pills may help reduce vasomotor symptoms that can disrupt sleep during perimenopause.
Improving Bone Density: Bone loss occurs more quickly during the menopause transition. Because estrogen and progesterone support bone health, combined oral contraceptives can help women preserve bone mineral density (BMD).
Stabilizing Mood: While mood changes can be a side effect of birth control pills, some women may experience improvements in mood, particularly relief from depression symptoms.
The Key Differences: Birth Control Pills vs. Hormone Replacement Therapy (HRT)
Birth control pills and HRT may contain similar hormones, but they are not the same. They are two distinct medications that serve different purposes and use different types and doses of estrogen and progesterone.
Feature | Low-Dose Birth Control Pills | Hormone Replacement Therapy (HRT) |
Primary Purpose | Pregnancy prevention | Menopausal symptom relief |
Hormone Doses | Higher (synthetic) | Lower (often bioidentical) |
Why It Matters | Higher doses are needed to stop ovulation | Lower doses are used to supplement declining hormone levels |
Best For | Healthy, non-smoking women of reproductive age in need of contraception, including perimenopausal women | Perimenopausal women using contraception who are in need of symptom relief or postmenopausal women, since they are no longer fertile |
Combined birth control pills contain synthetic estrogen and a progestin. They also deliver higher doses of estrogen than HRT to override the body’s natural hormone cycle and prevent pregnancy. Birth control pills are best suited for healthy, non-smoking women who need contraception and are still getting periods, whether their cycles are regular or irregular.(2)(4)
Unlike birth control pills, HRT is not meant to disrupt women’s natural hormone cycle. Rather, the treatment helps restore healthy hormone levels by increasing levels of estrogen and progesterone to reduce menopausal symptoms like hot flashes, night sweats, and vaginal dryness. Because replenishing hormone levels is a simpler process than stopping ovulation, HRT uses lower doses of estrogen than oral contraceptives.(4)
HRT and birth control pills also use different forms of progesterone for different purposes. In birth control, synthetic progestin primarily blocks ovulation, while in HRT, the progesterone is used to protect the uterus.(2)
HRT is not a form of contraception and is best suited for women who are using contraceptives but also want relief from perimenopausal symptoms. The treatment is also appropriate for postmenopausal women, since they are no longer fertile.
Similar to birth control pills, some forms of HRT use synthetic hormones. However, there are also bioidentical options. These hormones are structurally identical to the ones made in the body.
Is it safe to take birth control in your 40s and 50s?
Age is not considered a contraindication for birth control use.(6) According to the American College of Obstetricians and Gynecologists (ACOG) and the Menopause Society, it’s safe for most women to continue using birth control until they reach menopause or until ages 50 to 55, when the chances of conception are extremely low.(7)(8)(9) Menopause is defined as going 12 months in a row without a menstrual period, and most women in the U.S. reach this milestone at the average age of 51.(9)
At Winona, it’s recommended that women continue to use birth control for pregnancy prevention until the age of 50 regardless of menopause age.
The risk of certain health conditions increases with combined oral contraceptive use as women age, particularly cardiovascular risks. It’s important to consult with a doctor, who will consider age, individual risk factors, the likelihood of pregnancy, and possible alternative contraception options to determine when it’s appropriate to stop using birth control pills.(6)
Combined birth control pills may not be safe for some women in their 40s and 50s if they have one or more of the following risk factors:(7)(10)
Coronary artery disease
High risk of venous thromboembolism
High blood pressure
Blood clots
Obesity
History of stroke, mini-stroke, or other cerebrovascular disease
Diabetes
Migraine headaches
Estrogen-dependent cancers (breast cancer, endometrial cancer, etc.)
Cancerous or non-cancerous liver tumors
Undiagnosed abnormal vaginal bleeding
Use of certain medications
Smoking
Pregnancy
The "Masking" Effect: How do you know you've reached menopause?
It can be hard for women to tell whether they’ve reached menopause while on the pill. This is because hormonal birth control methods cause monthly withdrawal bleeding. This can mask the signs of natural menopause, leaving women with no way of knowing if their real periods have stopped.
Women who are no longer in need of contraception and want to know whether they’ve reached menopause may be able to do so by stopping hormonal birth control for a couple of months to see if their periods come back.
Winona doesn’t recommend hormone testing to diagnose menopause because hormone levels fluctuate throughout the day, which can produce inconsistent test results. Instead, we base the diagnosis on a woman’s age, symptoms, and medical history.
Generally speaking, the following guidelines are recommended regarding menopause and birth control use:(4)(6)(11)
Contraceptives Containing Estrogen
Women aged 40–49 who use birth control methods containing estrogen (combined oral birth control pills, patches, rings) may continue to do so until the age of 50 or older, as long as they have no heart health concerns.
Women 50 and older can continue using estrogen-containing birth control until the age of 55 if they are not at risk for heart problems. Another option is to switch to a nonhormonal form of contraception and stop use after 12 months have passed without a period. Nonhormonal contraceptives can make it easier to determine whether menopause has occurred, since they don’t cause withdrawal bleeding that can mask the stopping of natural periods.
Progestin-Only Birth Control
Women in their 40s who use progestin-only birth control methods (pills, hormonal IUDs, implants, injections) can continue doing so through age 55.
Women aged 50 and older may also continue using progestin-only contraceptives until age 55. As with estrogen-containing methods, they can alternatively switch to a hormone-free option and stop use after they’ve gone one full year without a menstrual period.
Nonhormonal or Barrier Methods
Women under 50 using nonhormonal or barrier methods of birth control may stop once they have gone two years without a menstrual period. These methods include copper IUDs, condoms, and diaphragms, among others.
Women 50 years of age and older can continue to use nonhormonal methods of birth control until they have gone one full year without a menstrual period.
Making the Switch: Transitioning from Birth Control to HRT
Hormonal birth control isn’t intended for menopausal symptom relief, and for some women, staying on birth control later in life can come with health risks. HRT is an effective, lasting solution for symptom relief and long-term health benefits, making it a more appropriate fit for women in postmenopause.
Birth control pills and HRT can be safely taken together during perimenopause for women still in need of contraception. For women who are no longer in need of contraception and want to transition completely from birth control to HRT, the first step is to consult with a knowledgeable physician.
A doctor can provide guidance on how to safely discontinue birth control and discuss any potential side effects. Oral contraceptives can typically be stopped at any time a woman chooses — no tapering necessary. IUDs and implants must be removed by a specialist.(12) Once a woman is off hormonal birth control, she and her doctor can monitor for menopausal symptoms and the cessation of periods.
The final step is to decide on an HRT treatment plan tailored to your health needs and lifestyle. This may include using oral tablets or capsules, transdermal patches, body creams, or localized vaginal treatments. If you’re currently navigating the transition from contraception to symptom relief, Winona can help set you on the right path. Take our brief health quiz to see if personalized, bioidentical menopause treatment is the right choice for you.
