Is Lo Loestrin (ethinyl estradiol and norethindrone acetate) birth control beneficial during perimenopause?

Lo Loestrin Birth Control During Perimenopause: Benefits and Considerations

Lo Loestrin (ethinyl estradiol and norethindrone acetate) birth control is not recommended specifically for prevention of chronic conditions during perimenopause, but may be beneficial for contraception and symptom management when used at the lowest effective dose for the shortest necessary duration.

Understanding Perimenopause and Contraceptive Needs

• Perimenopause is a time of reduced but not absent fertility, making contraception still necessary to prevent unintended pregnancies 1
• Women over 40 experience 75% unplanned pregnancies, which can have significant physical and emotional impacts 2
• Until menopause is confirmed, some potential for pregnancy remains; at age 45, women's sterility rate is only 55% 2

Benefits of Lo Loestrin During Perimenopause

• Combined hormonal contraceptives like Lo Loestrin can help control menstrual irregularities and relieve perimenopausal symptoms 1
• Hormonal contraceptives in perimenopausal women have shown statistically significant improvements in symptom management in six out of nine studies 3
• Additional benefits may include protection against bone loss, iron deficiency anemia, dysmenorrhea, benign breast disease, endometrial cancer, and epithelial ovarian cancer 4

Risks and Considerations

• The U.S. Preventive Services Task Force recommends against using combined estrogen and progestin for prevention of chronic conditions in postmenopausal women (Grade D recommendation) 5
• For every 10,000 women taking combined estrogen and progestin for 1 year, there may be 7 additional CHD events, 8 more strokes, 8 more pulmonary emboli, and 8 more invasive breast cancers 5
• However, these recommendations specifically do not apply to women using hormone therapy for management of menopausal symptoms 5

Practical Approach for Lo Loestrin Use in Perimenopause

• The American Academy of Family Physicians recommends using the lowest effective dose of hormonal therapy for the shortest possible time to manage menopausal symptoms 6
• Lo Loestrin contains a low dose of ethinyl estradiol (10 mcg) and norethindrone acetate (1 mg), making it a lower-dose option 7
• Consider individual risk factors for cardiovascular disease, thromboembolism, and breast cancer before prescribing 6
• Transdermal estrogen administration may be preferable for women with risk factors for thromboembolism 6

When to Transition from Contraception to HRT

• Contraceptive therapy should be continued until menopause is confirmed, as hormonal levels fluctuate widely during perimenopause 2
• Consider transitioning from Lo Loestrin to postmenopausal hormone replacement therapy when menopause is confirmed 4
• The levonorgestrel intrauterine system with supplemental low-dose menopausal estrogen may be an alternative option with positive results for managing perimenopausal symptoms 3

Cautions and Contraindications

• Combined hormonal contraceptives like Lo Loestrin should be used with caution in women with cardiovascular risk factors 2
• The CDC's Medical Eligibility Criteria for Contraceptive Use should guide choices for women with comorbidities 2
• No contraceptive method is contraindicated based on age alone, but individual health factors must be considered 1