From the Guidelines
The best oral contraceptive for perimenopause is a low-dose combination pill containing both estrogen and progestin, such as those with 20-35 mcg of ethinyl estradiol combined with a progestin like norethindrone acetate or levonorgestrel, due to its ability to manage perimenopausal symptoms and provide contraception until menopause is confirmed 1. When selecting an oral contraceptive for perimenopause, it's essential to consider the woman's individual health history, symptoms, and risk factors.
- The estrogen component in combination pills helps supplement declining natural estrogen levels, reducing symptoms like hot flashes and irregular bleeding.
- The progestin component protects the uterine lining, reducing the risk of endometrial hyperplasia and cancer.
- For women who cannot take estrogen due to risk factors like smoking, high blood pressure, or history of blood clots, progestin-only pills (mini-pills) like Micronor or Camila are safer alternatives 1. Some key points to consider when prescribing oral contraceptives for perimenopause include:
- The median age of menopause is approximately 51 years in North America, but can vary from ages 40 to 60 years 1.
- Pregnancies among women of advanced reproductive age are at higher risk for maternal complications, such as hemorrhage, venous thromboembolism, and death, and fetal complications, such as spontaneous abortion, stillbirth, and congenital anomalies 1.
- The risks associated with continuing contraception, in particular risks for acute cardiovascular events (venous thromboembolism, myocardial infarction, or stroke) or breast cancer, also need to be considered 1. It's crucial to evaluate individual health history, symptoms, and risk factors before prescribing, as some women may need adjustments based on their specific symptoms or side effects.
- A healthcare provider should assess the woman's overall health and medical history to determine the best oral contraceptive option for her specific needs 1.
- Regular follow-up appointments are necessary to monitor the woman's symptoms, side effects, and overall health while using oral contraceptives during perimenopause 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Oral Contraceptives for Perimenopause
- The use of combined oral contraceptives (COC) in perimenopausal women is a viable option for contraception and can help control symptoms such as menstrual irregularity, heavy menstrual bleeding, and vasomotor symptoms 2.
- COCs can also reduce the risk of ovarian cancer, endometrial cancer, and colorectal cancer in perimenopausal women 2.
- There is no evidence to suggest that taking COCs increases the risk of cardiovascular events or breast cancer in middle-aged women compared to other age groups 2.
Types of Oral Contraceptives
- Extended-cycle oral contraceptives, such as those containing levonorgestrel 100 μg and ethinyl estradiol 20 μg, are a low-dose option that can provide similar efficacy and tolerability to other extended-regimen OCs 3.
- Monophasic combination oral contraceptives, such as Alesse, containing levonorgestrel 100 μg and ethinyl estradiol 20 μg, have been shown to be effective and safe in clinical trials 4.
- Low-dose oral contraceptive preparations, such as those containing 20 μg of ethinyl estradiol and 0.15 mg desogestrel, can help prevent bone loss and increase bone density in perimenopausal women 5, 6.
Benefits of Oral Contraceptives in Perimenopause
- Oral contraceptives can help regulate menstrual cycles and reduce the risk of unintended pregnancy in perimenopausal women 2.
- They can also improve symptoms such as hot flashes and night sweats, and reduce the risk of osteoporosis and fractures 5, 6.
- Additionally, oral contraceptives can provide a low-dose option for hormone replacement therapy in perimenopausal women, which can help alleviate symptoms and prevent bone loss 5, 6.