One common question I hear is: What are the benefits of combination hormonal birth control during perimenopause?

Perimenopause is the time before menopause, when hormone levels change and periods can become irregular. Even though fertility is lower, pregnancy can still happen. Combination hormonal contraceptives—birth control that contains both estrogen and progesterone—can be very helpful during this stage of life.

One major benefit is relief from vasomotor symptoms, like hot flashes and night sweats. If you or your loved one is perimenopausal, you can appreciate how disruptive hot flashes and night sweats are. These vasomotor symptoms happen when estrogen levels go up and down. Combination birth control provides steady hormones, which helps calm these symptoms and improve daily comfort.

Another benefit is that combination hormonal contraceptives help make irregular vaginal bleeding regular. Many women in perimenopause have periods that come too often, too far apart, or without warning. Birth control pills can help make periods more predictable and manageable.

Some women experience very heavy bleeding that feels like flooding or gushing. Combination oral contraceptive pills and progesterone-releasing IUDs are both very effective at treating heavy menstrual bleeding. For many women, bleeding becomes much lighter or even stops completely.

Bone health is also very important during perimenopause. Combination oral contraceptive pills can increase bone mineral density in this age group. A large Swedish study found that women who used birth control pills—especially for many years and during their 40s—had a lower risk of hip fractures after menopause. This benefit is long lasting.

Combination oral contraceptives also have important non-birth-control benefits. They significantly lower the risk of endometrial (uterine) cancer and ovarian cancer. The protection against ovarian cancer is especially strong and can last for up to 40 years after stopping the pill.

Another advantage is flexibility. Women using combination birth control pills can choose when and how often to have a period. Some pill packs are made to allow a period every three months. Others use a standard 28-day pack, and women can skip the placebo pills to skip a period that month. Vaginal contraceptive rings, which also contain estrogen and progesterone, can be used continuously for 28 days without a ring-free week to skip periods as well.

Many women ask how long they can safely stay on combination birth control. If contraception is not needed, such as when a partner is female or has had a vasectomy, pills are often stopped around age 50, and menopausal hormone therapy can be discussed. For women who still need pregnancy prevention, combination birth control can often be continued until age 52 or even 55. By age 55, about 90% of women have reached menopause.

Blood tests are not helpful during perimenopause. Hormone levels change day to day. A test may look high one day and low the next, which can be confusing and misleading. I do not get lab tests if the results are not something that I can address effectively.

Finally, progesterone (levonorgestrel) IUDs are especially helpful during perimenopause. They provide reliable birth control, reduce or stop bleeding, and make it easier to use estrogen safely to treat perimenopausal or postmenopausal symptoms.

Perimenopause can be challenging, but the right treatment can make this time healthier, more comfortable, and easier to manage. I am a Menopause Society–certified provider, and I see patients at 745 West Moana Lane in Reno, Nevada. Call 775 657 2025 for an appointment with me.