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Birth Control and Menopause: What You Should Understand

10.27.2021

While it becomes increasingly difficult for a woman to get pregnant as she moves into her 40s and approaches menopause, it’s not impossible. Just because you’ve skipped a period here and there doesn’t mean that you’ve actually reached menopause, which is defined as the moment you’ve gone a full 12 months without menstruating. Until that time you’re in perimenopause, a transitional phase when you are still ovulating, but not regularly. Perimenopause is the beginning of the end of your reproductive cycle, but it’s still quite possible to become pregnant during this time. If you want to avoid pregnancy, it’s important to continue using some form of contraception until you’ve officially reached menopause.

While there are many different forms of birth control available, women often wonder when they can stop taking hormonal contraceptives during the menopausal transition. Although it may seem like this answer should be straightforward, there’s more to consider than simply when you reach menopause. Here are some things you should know about menopause and hormonal birth control:

5 Things to Know About Menopause and Birth Control

Hormonal birth control may mask the symptoms of menopause. If you use the pill, the patch or other hormonal forms of birth control, the hormones used to prevent pregnancy can also mask the symptoms of menopause. This is because most hormonal birth control contains a combination of synthetic estrogen and progestin, delivering a fixed amount of each to the body during 21 or 24 day cycles. This set dosage means the ovaries don’t actually produce the usual amount of these hormones — they can take it easy while the birth control does the work.¹ But it also means you may not be able to see the signs of your body’s fluctuating hormone levels during perimenopause as clearly.
Hormonal birth control makes your menstrual cycle more regular. Remember when we said the synthetic hormones in birth control might mask certain signs of menopause? One of those signs is increasingly irregular periods. Since birth control can help regulate cycles with a reliable daily dose of estrogen and progestin, you may not know your periods are actually becoming more irregular until you’ve gone off the pill.²
You may continue to cycle even after you’ve reached menopause on birth control. If you do take birth control pills during the menopausal transition, don’t be surprised if you continue to bleed as if you were getting your period, even after you’ve reached menopause. The same synthetic hormones that regulate cycles actually do so by causing a “fake period,” also known as withdrawal bleeding. If you keep taking the pill after reaching menopause, you may continue to experience withdrawal bleeding, even though your reproductive cycle has ended.
Your healthcare provider may recommend birth control to help you through menopause. Some healthcare providers prescribe low-dose birth control pills to perimenopausal women. They prevent pregnancy while also providing other benefits: they can alleviate disruptive menopause symptoms like hot flashes, help regulate heavy or irregular periods, and even prevent bone loss, which can lead to osteoporosis.
Hormones are not your only option. The pill, patch or other forms of hormonal birth control are just one route to consider and are not appropriate for some women. Women who smoke, or have had a stroke, heart attack, diabetes, high blood pressure or blood clots should not use estrogen containing hormonal contraception. In these cases, progesterone-only hormonal contraception may be an alternative option. Some women also have different physical responses to the pill and choose to avoid hormones because of the negative side effects they experience. Regardless of your reason for not choosing hormonal birth control, it’s important you find an alternative contraceptive to avoid unwanted pregnancy before you reach menopause. If you’re not sure where to start, talk to your healthcare provider. They can walk you through available options and make recommendations to fit your individual needs.

Whether you’re thinking of quitting hormonal birth control or are wondering if you should start taking it as you approach menopause, talk to your healthcare provider before making any moves. There’s more than just the timing of menopause to consider when it comes to contraceptives, and they can help you build a game plan that fits your needs as you approach this next phase of life.

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