For over 50 years, birth control pills have been pushed on women as the optimal method of contraception.  The reliability of other methods of birth control has been downplayed and women have even been told that our periods are “bad” or “dangerous.” They are also told that going on The Pill as early as their teenage years, and staying on it except to have children, will prevent long term health problems.

In addition, birth control pills are widely prescribed as a convenient way to put the perimenopausal body and it’s symptoms on autopilot until it’s time to move on to conventional hormone therapy (HRT).

Like most OB/GYNs, I’ve prescribed my share of birth control pills, even though I’ve long argued that there are safer alternatives that are just as effective when used conscientiously. As long as you don’t mind putting your ovaries on “automatic pilot” and ignoring your fertility, there’s nothing that comes close to the pill for sheer convenience.

When To Use Birth Control Pills

I prefer to keep my hormones tuned into the cycle of the moon and the planets rather than the energy of the pharmaceutical companies. However, birth control pills can have positive benefits for some women and may even be indicated as the best options in certain cases.

Here are a few reasons why women choose to use birth control pills during perimenopause:

Regulating heavy periods. Birth control pills can help regulate heavy, irregular periods that are common during perimenopause. This can be a Godsend for women in the 40s and 50s who have busy schedules or who simply do not want to deal with the inconvenience.

Preventing Unplanned Pregnancy. Many women, including women during perimenopause, don’t have conscious dominion over their fertility. Birth control pills can be a good option women for these women who are unwilling or unable to use more natural means to prevent pregnancy. 

Ease Fibroid Pain: All pelvic conditions tend to quiet down when the natural hormonal cycles are put to sleep by the steady flow of synthetic hormones. Birth control pills are a combination of synthetic estrogen and progestin. Birth control pills help smooth out estrogen dominance that can cause fibroids to grow or become otherwise symptomatic. It can also help with symptoms related to Polycystic Ovarian Syndrome ( PCOS) and Premenstrual Syndrome (PMS). But because birth control pills are synthetic, I only recommend them in these instances after natural approaches such as dietary changes or acupuncture have failed.

Alleviate Hormonal Imbalance. Taking low-dose birth control pills has been shown to alleviate some of the common symptoms women experience during perimenopause including hot flashes, night sweats, mood swings, breast tenderness, bloating and more.

Clear Up Midlife Acne. Birth control pills have long been used to help with teen acne. And oral contraceptives are also used to help with midlife acne during perimenopause when hormonal imbalance is the cause. Women with excess androgen (i.e. testosterone or DHEA levels that are too high) should choose a pill that has antiandrogenic effects. But note that the more antiandrogenic pills can have a negative effect on libido. 

Birth Control Pills and Your Sex Life

As I have always advised, there are inherent risks with all drugs. And birth control pills are no different. All birth control pills consist of synthetic hormones that mask our natural hormonal rhythms along with the messages about our health that they convey. And like most magic bullets, The Pill definitely has its downsides.

Ironically, one very significant downside is the fact that the pill can lower your sex drive! And since perimenopause can also cause unwanted changes in sexual function—including decreased sexual activity and problems with orgasm—birth control pills can make matters worse.

Birth control pills are comprised of potent synthetic estrogens and progestins that diminish the levels of the pituitary hormones known as follicle stimulating hormones (FSH) and luteinizing hormone (LH). This results in the metabolic suppression of ovarian function, including both the suppression of ovulation and testosterone production!

In addition, birth control pills cause a marked increase in the production of sex hormone binding globulin (SHBG) in the liver. The higher the SHBG levels, the more hormones are “bound” and thus unavailable for biologic effects on tissues. Studies have shown SHBG levels to be 4 times higher in Pill users than in those who had never used The Pill. This means that although a woman taking birth control pills produces testosterone in her body, it’s unavailable for normal use such as stimulating her sex drive.

Even more worrisome is that SHBG levels can remain elevated in women for at least 6 months after they stop taking the pill. But no one knows exactly how long this effect lasts. Many researchers are concerned that prolonged exposure to synthetic hormones induces gene-imprinted and increased gene expression of SHBG in the liver in some women who have used The Pill.

Other Side Effects of Oral Contraceptives at Midlife

For women who use birth control pills to alleviate the symptoms they experience during perimenopause it can be difficult to know if and when they actually transition to menopause. This is because the sugar pill week causes withdrawal bleeding (similar to a period), and this can continue even after a woman has transitioned to menopause.

For these women it makes sense to get an FSH test or other menopause test when they are on a break from taking The Pill, and to work closely with a knowledgeable health care provider.

Of course there are other potentially serious “side effects” as well, including headaches, PMS, blood clots, breast cancer, heart attacks, and stroke.

My Advice for Women Using Birth Control Pills

For women who choose to take birth control pills during perimenopause or at any other time in their lives, I highly recommend taking measures to support your body and it’s natural processes.

Here are some of the ways all women can mitigate some of the negative effects of birth control pills:

1. Take the lowest dose. Birth control pills have come a long way in the last 40-plus years. There are many different options at much lower doses than previous generations of oral contraceptive. Start with the lowest dose of the birth control and only use it for as long as necessary.

2. Take a multivitamin and mineral supplement. Nutritional supplements can be a great way to support your body. While there is no magic bullet, I women take a high-quality, pharmaceutical-grade multivitamin and mineral combination rich in B vitamins. The hormones in the pill change a large number of metabolic functions in your body, including putting increased pressure on the liver to metabolize those synthetic hormones. When you take a good multivitamin/mineral regularly, you provide your body with the materials it needs to do its job well. Do your research and choose one that resonates with you. Try it for a month or so. You many need to add additional supplements or change it up from time to time.

3. Limit sugar. Healthy habits go a long way toward achieving healthy hormone balance and less severe symptoms during perimenopause. I have had many women tell me that they know when they eat chocolate or drink a glass of red wine they experience hot flashes. I recommend limiting sugar in all forms, including white foods and alcohol.
4. Eat a low glycemic diet. A nutrient-dense, low glycemic diet with adequate protein, healthy fats, and complex carbohydrates will support your body’s ability to produce sex hormones and has helped many women stave off weight gain from birth control pills as well as natural hormonal fluctuations that occur during perimenopause. Try to eat organic foods or the highest quality food you are able to afford, and drink filtered water. Avoid packaged foods with known toxins. Toxins are everywhere, including in our food and water supply. Taking birth control pills places additional stress on your liver and other detoxification pathways. In my book The Wisdom of Menopause I lay out my Menopause Food Plan in detail.

5. Exercise regularly. Get some form of cardiovascular exercise, as well as weight bearing and stress reduction exercises such as deep breathing. 

6. Plan for pleasure. Your body is hard wired for pleasure. Whether or not The Pill decreases your libido, it is still possible to enjoy sex. You just need to plan for it! Many people operate under the erroneous belief that sex is supposed to be spontaneous, and that there is something wrong with your sex life if you plan for it. Nothing could be farther from the truth! If you want to have a good sex life, you have to pay attention to it. What we pay attention to expands. That means making time for arousal and sex, even if it means jotting it in your Day Timer! (By the way, that includes making time for self-pleasuring, too!)

7. Try herbs to wean off The Pill. When you feel ready to try something more natural, herbs can be a great way to transition and avoid withdrawal symptoms. I’m a huge fan of Pueraria mirifica and my Amata products have helped many women. There are also many other menopause herbs you can try. You can start taking herbs while you are still taking birth control pills, and then after a month stop taking The Pill. Your body may take a little time to even out, and you may need to adjust your herbs as you go. This is normal. Be patient and work with a knowledgeable herbalist or health care practitioner.

Remember, each of us is unique. What works for one woman won’t work for another. And that includes birth control pills. What is your experience?