From the Guidelines
Yes, oral contraceptive pills (OCPs) can be prescribed for perimenopausal bleeding with tachycardia-type hot flashes, provided there are no contraindications, as supported by the most recent evidence from 1.
Key Considerations
- A low-dose combination OCP containing 20-35 mcg of ethinyl estradiol with a progestin (such as norethindrone or levonorgestrel) is typically recommended.
- The regimen usually involves taking active pills for 21 days followed by 7 days of placebo pills, or continuous active pills to eliminate withdrawal bleeding.
- OCPs help regulate menstrual cycles, reduce heavy bleeding, and alleviate vasomotor symptoms like hot flashes by providing steady hormone levels.
Important Evaluations
- Before prescribing, evaluate for contraindications including history of venous thromboembolism, uncontrolled hypertension, migraine with aura, active liver disease, or estrogen-dependent cancers.
- Blood pressure monitoring is important, especially with the tachycardia symptoms, as noted in 1.
Alternative Considerations
- For women over 35 who smoke or have cardiovascular risk factors, consider non-estrogen alternatives like progestin-only pills or an IUD.
- OCPs can be used safely through perimenopause until menopause is confirmed, typically after 12 months without menses.
Additional Options
- Nonhormonal medications like SNRIs and SSRIs can decrease the intensity and severity of vasomotor symptoms, as discussed in 1, 1, and 1.
- Lifestyle modifications and environmental changes may also help decrease the intensity and severity of menopausal symptoms.
From the Research
Perimenopausal Bleeding and Hot Flashes
- Perimenopausal bleeding with tachycardia type hot flashes can be managed with various treatment options, including hormonal and nonhormonal therapies 2, 3, 4, 5, 6.
- Hormonal replacement therapy (HRT) is often considered the first-line treatment for bothersome vasomotor symptoms and genitourinary syndrome of menopause (GSM) symptoms 2.
- However, for perimenopausal women, oral contraceptives (OCPs) can be a beneficial option, providing effective contraception, regulating menses, and reducing the risk of endometrial and ovarian cancers 5.
- OCPs can also relieve vasomotor symptoms in perimenopausal women, making them a viable treatment option for those experiencing hot flashes and other menopausal symptoms 5.
Oral Contraceptives as a Treatment Option
- OCPs can be used to manage perimenopausal symptoms, including hot flashes and irregular bleeding 5.
- The use of OCPs in perimenopausal women has been found to decrease the risk of postmenopausal hip fractures and reduce the need for surgical intervention for benign menstrual conditions 5.
- However, it is essential to note that OCPs may not be suitable for all perimenopausal women, particularly those with certain medical conditions or risk factors, such as smoking or hypertension 5.
Nonhormonal Therapies
- Nonhormonal therapies, such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can also be effective in reducing the frequency and severity of hot flashes in menopausal women 4, 6.
- Other nonhormonal options, including clonidine and gabapentin, may also be beneficial in managing hot flashes, although the evidence is limited, and more research is needed to fully understand their efficacy and safety 6.