Why are we talking about this? With an estimated 25% of women ages 15 - 44 using it, the oral birth control pill is the most common form of contraception in the US (Cooper & Patel, 2024). Understanding their prevalence and their use of hormones to function, it is important for women to understand how their contraceptives may or may not potentially be impacting how they experience perimenopause and menopause. 

 

Types of Oral Birth Control. 

 

• Combined Oral Contraceptives (COCs). These are the most commonly prescribed pills. They contain both progesterone (prevents pregnancy) & estrogen (controls bleeding) (Baird & Glasier, 1993) and typically contain 21 days of hormone pills and 7 days of placebo pills which allows for monthly bleeding. The pill is also prescribed for other issues related to menstruation including pain, irregularity (Bishop et al, 1960), migraines without aura, and acne (Redmond et al, 1997) to name a few (Maguire & Westhoff, 2011). 

• Progestin-Only Pills aka POPs or Minipills. These pills contain progestin only.  Opill (norgestrel) is the first daily oral contraceptive approved by the FDA for over the counter use without a prescription and fits within this category. 

• Extended Cycle / Continuous Use Pills. These are COCs which provide a much longer time period between hormone free pills and bleeding. These may be packaged as 84 hormone or active pills and 7 placebo inactive pills. Your health care provider may also instruct you on how to use one of the typical COCs in an extended use fashion.

 

Potential Impact of Oral Birth Control on Perimenopause Symptoms & Changes 

 

Regular bleeding. Both the COC and Extended Cycle pills described above provide for more regular bleeding and create a sense of predictability around bleeding.  For many women, this removes the bothersome element of unpredictable menstrual bleeding which accompanies perimenopause. The regular bleeding via the contraceptive pill removes the period as a physical  indicator for entry into perimenopause transition.  Age and symptoms are more likely to help your physician figure out where you MAY be. 

 

Physical symptom management. For many women, the peaks and valleys of the variable hormone levels of perimenopause are the most bothersome. These hormone fluctuations can contribute to many of the physical, cognitive, mood and sleep symptoms that disrupt daily function. These peaks and valleys are caused by cycles without ovulation, or cycles with multiple ovulations (LOOP cycles). Often physicians will advise to use hormonal contraception to manage this ovulation variability rather than the postmenopause hormone therapy regimens that will not address ovulation. The birth control pills’s mechanism of suppression of ovulation will “clamp” down this hormone variability and thus help a lot with management of symptoms in perimenopause. (It is important to note that some progesterone only pills do not act by blocking ovulation)

 

Bone mineral density. Both the COC and Extended Cycle pills have been linked to an increase in bone mineral density for those women who are in perimenopause or immediately post menopause roughly age 46 - 53 while those who are not on the pill experience a decrease. The bone mineral density for women who are taking birth control pills prior to perimenopause did not seem to be impacted by COCs. (Isley & Kaunitz, 2011) Low bone mineral density can lead to a higher risk of fractures late in life. 

 

 

How will I know if I've entered into menopause? The Menopause Society states 90% of women will reach menopause by age 55 and recommends the continued use of contraception until then or menopause is confirmed. It is a complex question to determine if you are in menopause if you’re on an oral birth control pill. If you are NOT at risk for pregnancy, your physician may advise that you stop taking the pill and monitor natural period patterns as they return. If you don’t have a period for 1 year, then you’re in menopause. 

Some popular websites and medical providers will advocate for hormone testing to determine where in the process you are. This is not likely to be helpful or predictive. Hormone testing has very limited use and can be very expensive. One month to the next, and one day to the next, is highly variable with regards to hormone levels in perimenopause and tell us nothing about what will happen the next month. Birth control pills will impact the hormone levels that are tested. Working with a knowledgeable health provider certified by The Menopause Society will be helpful in guiding you through this transition. 

 

 

Note: If you're on birth control or considering starting birth control, it is VERY important to collaborate with your healthcare team to find the best form of birth control for you. For women in their 40's the type of birth control is more person-dependent than age-dependent. Health risks change as we get older, and this will influence your choice of safe and effective contraceptive management. Your primary care team will be able to help find the right solution for you. (Primary Care Notebook, 2026)