TL;DR (Too Long; Didn't Read)

Today, we are discussing why the birth control pill is often offered for perimenopausal women.

This column is not intended as medical advice. You should always speak to your doctor about your specific history and what options are appropriate for you and available to you.

WHY

In an upcoming episode in my Premium Membership, EVEN BETTER! I discuss what I have decided to do as a non-symptomatic woman (regular cycles, no hot flashes, no sleep issues, no mood changes, no weird ear tingling or skin issues) in perimenopause regarding hormone replacement therapy. It’s a discussion taking both a short-term and long-term view of women’s health with Cynthia Thurlow, ND, on our monthly “She Said, She Said” episode. To listen in and to hear what I am doing, you’ll want to JOIN HERE.

Related to this, I’m often asked, which is better (or what’s the difference between)–birth control or hormone replacement therapy (HRT)?

It’s a reasonable question. Birth control = hormones. HRT = hormones. Birth control has a relatively neutral (and perhaps net positive) image, and HRT still scares the bejeezus out of many women who’ve heard conflicting information about heart attack and breast cancer risk.

Let’s break it down.

WHAT

Birth control pills are often offered as hormone therapy for perimenopausal women because they “regulate” (note the quotations) and appear to ease symptoms like hot flashes, irregular bleeding, and cycle length changes.

I find the cultural attitudes towards each quite interesting. Both are hormones. One is often viewed as a beacon for women’s freedom, and the other is a way to cheat aging because menopause is “natural,” and we should just “accept it.”

So, before I continue… This attitude around menopause as a natural state and normal fate needs to bite. the. dust.

If you’ve ever taken an antibiotic, this argument crumbles like a house of cards. Bacteria and viruses are part of the natural world. Just because they’re natural doesn't mean we should ride out an infection naturally (in which case you might not survive it).

If you’ve ever put on skin cream, brushed your teeth, or put on a winter coat when it's cold outside, this logic of “natural” falls down. So, you should leave your skin in its natural state–oily, dry, acneic, or wrinkly; you shouldn’t brush the natural film off your teeth; and if it's cold outside, well, just bear the natural elements.

I’m being intentionally sarcastic to demonstrate how silly it is to think women should suffer because of declining hormones. It is a cruel way to view our elders and ourselves. How about we have the option to live our best lives as each of us sees fit?

But I digress.

HOW

Hormone replacement therapy adds hormones to what your body is already producing, whereas the birth control pill suppresses your own hormone production and replaces it with a steady dose of synthetic hormones.

The purported benefits of birth control pills during perimenopause include:

• Regulating the menstrual cycle
• Reducing hot flashes
• Lowering endometrial and ovarian cancer risk
• And, of course, providing birth control (yes, you can still get pregnant in your 40s!)

Birth control pill risks often aren’t discussed enough. Birth control is commonly described as “low dose estrogen,” which falsely vilifies estrogen as something to be wary of. But as we age, we have less estrogen than we did in our 20s and 30s.

Birth control pills more often have a higher dose of estrogen than hormone replacement therapy. This is arguably better for women who are going through early menopause or primary ovarian insufficiency (POI) but not necessarily for women who don't have POI and are struggling with brain changes, mood changes, sleep changes, and the many and wide-ranging symptoms of perimenopause.

The birth control pill has several documented side effects that should not be ignored:

• Blood clots
• Extreme nausea
• Low libido (how ironic that you can now freely have sex, but now you don’t want to)
• Breast tenderness
• Headaches
• Weight gain
• Changes your smell
• Causes systemic inflammation (via the NFκB pathway) by upregulating cytokines
• Gobbles up antioxidants like CoQ10
• Can cause lipid changes
• Causes increase in depression via degradation of tryptophan

NOW

I’m not really a fan of the pill for its original intended use of contraception. I’m even less of a fan of the pill for perimenopause.

Does that mean it is never indicated or useful? Of course not. However, the option of discussing hormone replacement therapy should be available to all women.

What I Recommend

Gift of Health Guide 2024

You’ll find my top choices at special discounts!

• General Health Support: From compression boots to a thermoregulation wrist wearable.
• Recovery Practice Must-Haves: Check out a cold plunge tub, sauna options, and red light therapy devices.
• Fitness Goals: Minimalist shoes for strength training days and an AI bike for your zone training.
• Skincare: Products for all skin types that address midlife skin concerns.

Consider giving meaningful gifts of health to yourself and those you love this season! Start Gifting! 

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