From the Guidelines
For perimenopausal symptoms, the best combined oral contraceptive (COC) option is typically a low-dose formulation containing 20-35 mcg of ethinyl estradiol combined with a newer generation progestin such as norgestimate, desogestrel, or drospirenone. Specific products like Yaz/Yasmin (containing drospirenone), Ortho-Cyclen/Sprintec (containing norgestimate), or Desogen/Marvelon (containing desogestrel) are good choices. These should be taken daily for 21 days followed by 7 days of placebo pills, or continuously if breakthrough bleeding is not problematic. These COCs effectively manage irregular bleeding, hot flashes, mood swings, and sleep disturbances while providing contraception. They work by stabilizing hormone levels, suppressing ovulation, and providing exogenous estrogen to compensate for declining natural levels. Women should use these until approximately age 51-52 or until menopause is confirmed, then transition to hormone replacement therapy if symptoms persist. COCs are contraindicated in women with history of blood clots, uncontrolled hypertension, certain migraines, liver disease, or smokers over 35, so medical screening is essential before starting 1.
Some key points to consider:
- The use of COCs for perimenopausal symptoms is supported by evidence from studies such as the Women's Health Initiative (WHI) 1.
- The choice of COC should be individualized based on the woman's medical history, risk factors, and preferences 1.
- Alternative options for managing perimenopausal symptoms, such as non-hormonal medications and lifestyle modifications, may also be considered 1.
It's essential to weigh the benefits and risks of COCs and other treatment options for perimenopausal symptoms, considering the individual woman's needs and health status 1.
From the Research
Best Contraceptive Options for Perimenopausal Symptoms
- Combined hormonal contraception (CHC) is a suitable option for perimenopausal women, as it can relieve symptoms such as menstrual irregularities, hot flashes, and mood disorders 2, 3, 4.
- Progestin-only methods can also be used, either alone or in combination with estrogen replacement therapy, to address both contraceptive needs and perimenopausal symptoms 2.
- Nonhormonal options are available for women who wish to avoid hormonal methods 2.
- The use of combined oral contraceptives (COCs) in perimenopausal women can help control menstrual irregularity, heavy menstrual bleeding, and vasomotor symptoms, while also reducing the risk of ovarian cancer, endometrial cancer, and colorectal cancer 5, 4.
- A levonorgestrel intrauterine device with supplemental low-dose menopausal estrogen may be a suitable option for managing disruptive perimenopausal symptoms and long-term outcomes 6.
Considerations for Contraceptive Choice
- Patient preference, medical co-morbidities, and perimenopausal symptoms should be taken into account when selecting a contraceptive method 2, 6.
- Clinicians and pharmacists should address specific patient risk factors, symptom profiles, long-term risks and benefits, and patient preferences when choosing a contraceptive for perimenopausal women 6.
- There is no evidence that taking COCs presents an increased risk of cardiovascular events or breast cancer for middle-aged women, and age itself is not a contraindication for COC use 5.