I recently attended a lecture about birth control needs for women in perimenopause. Perimenopause is characterized by wide hormone fluctuations and irregular menstrual cycles for 5 or more years preceding and lasts until 12 months of no-bleeding has been achieved. Perimenopause is the time periods may come closer together, farther apart, heavier, lighter, or stop and start again. How frustrating! Even though fertility goes down during this time, pregnancy can still happen.

As women get closer to their final menstrual period, ovulation happens less often. But it does not stop right away. This means pregnancy is still possible until menopause (one year after spontaneous menstrual period) is reached. Studies show that fertility rates change with age. At age 40, about 83% of women can still become pregnant. At age 45, this drops to 45%. By age 50, fertility is lower, but still present, at about 10%.

Pregnancy later in life also carries higher risks. For every 1,000 women age 50 and older who have a live birth, 230 will have an induced abortion. Only teenagers have a higher abortion rate. Women of older reproductive age are also seven times more likely to die from pregnancy-related causes compared to adolescents. Because of these risks, effective birth control is very important during perimenopause.

Many women can safely use combined hormonal birth control, which contains both estrogen and progesterone. This includes combination birth control pills. These are safe for women who do not have certain medical conditions. Examples of conditions where combined birth control should not be used include uncontrolled high blood pressure, history of venous thromboembolism, tobacco use with age 35 or older, or migraines with visual symptoms called aura.

In healthy, nonsmoking women without high-risk conditions, combined hormonal birth control can usually be continued until age 50 to 55.

If a woman has a contraindication to estrogen-containing contraception or heart or blood vessel risk factors, progesterone-only birth control is often a better choice. Options include progesterone-only daily pills, the Depo-Provera shot given every 12 weeks, the Nexplanon implant placed in the arm for up to three years, or an intrauterine device (IUD), which can last up to ten years depending on the type.

It is important to know that combination birth control pills do not increase the risk of breast cancer. They also have added benefits during perimenopause. Because they contain estrogen and progesterone, they can help reduce hot flashes and night sweats, which are common during this stage of life.

Some women in perimenopause have very heavy periods that feel like flooding or gushing. Combination birth control pills and progesterone-releasing IUDs are both very effective at treating heavy menstrual bleeding. Another benefit of combination birth control pills is that they can help maintain or increase bone strength, which becomes more important as women age.

Perimenopause can be a confusing time, but with the right birth control choice, women can protect their health, prevent unplanned pregnancy, and feel better during this transition. Seek out a healthcare professional to help you navigate this journey. If you are in Northern Nevada, I am a Menopause Society certified provider and you can see me at 745 West Moana in Reno! Call 775 657 2025 for an appointment.