From the Guidelines
For perimenopausal symptoms, the best combined oral contraceptive (COC) options are typically those containing estradiol or estradiol valerate rather than ethinyl estradiol, as they more closely resemble natural hormones. Specifically, pills like Natazia (estradiol valerate/dienogest) or Zoely (estradiol/nomegestrol acetate) are good choices, as supported by recent guidelines 1. These formulations can effectively manage irregular bleeding, hot flashes, mood changes, and sleep disturbances while providing contraception. The recommended approach is to start with a lower-dose formulation and adjust as needed. A typical regimen would be daily administration for 21-24 days followed by a 4-7 day hormone-free interval, though continuous use (skipping the hormone-free week) may better control symptoms. These estradiol-containing COCs may have a more favorable cardiovascular risk profile than traditional ethinyl estradiol pills, which is important as perimenopausal women often have increasing cardiovascular risk factors, as noted in studies 1. Treatment can continue until menopause is confirmed or until age 55, at which point contraception is no longer needed. Regular monitoring of blood pressure and discussion of any concerning symptoms is important during treatment, as emphasized in guidelines 1. It's also important to consider alternative treatments for specific symptoms, such as vaginal dryness, which can be treated with over-the-counter vaginal moisturizers, gels, oils, and topicals, or local hormonal treatments, as discussed in recent studies 1. Ultimately, the choice of treatment should be individualized based on the patient's specific needs and medical history.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Benefits of Combined Oral Contraceptives (COCs) for Perimenopausal Symptoms
- COCs can help control menstrual irregularity, heavy menstrual bleeding, and vasomotor symptoms in perimenopausal women 2, 3
- They can also reduce the risk of ovarian cancer, endometrial cancer, and colorectal cancer 2, 3
- Hormonal contraceptives, including COCs, have been shown to improve symptom management and long-term outcomes in perimenopausal women, including bone loss and metabolic parameters 4
Selection of COCs for Perimenopausal Women
- The choice of COC should be based on individual patient risk factors, symptom profiles, long-term risks and benefits, and patient preferences 4, 5
- A levonorgestrel intrauterine device with supplemental low-dose menopausal estrogen has been shown to have positive results for the management of disruptive perimenopausal symptoms and long-term outcomes 4
- Extended-cycle COCs, such as those containing ethinyl estradiol 20 μg/levonorgestrel 100 μg + ethinyl estradiol 10 μg, may be a suitable option for perimenopausal women, offering a low-dose, extended-regimen OC option without sacrificing efficacy or tolerability 6
Considerations for COC Use in Perimenopausal Women
- Age itself is not a contraindication for COC use, and the Centers for Disease Control and Prevention (CDC) do not list age as a contraindication for COC use 2
- Perimenopausal women should be counseled on the benefits and risks of COC use, including the potential for improved symptom management and reduced risk of certain cancers 2, 3