As I Approach Perimenopause, I’m Thinking About Birth Control Totally Differently

Whether you’re navigating infertility or are simply dealing with erratic periods, Dr. Mindy Goldman says, even in your 40s, pregnancy precautions are still the baseline reason to go on birth control. “Something I always remind women in their 40s is that their ovaries don’t just turn off overnight,” she explains. “While it may seem like our ovaries are shutting down, ovulation simply becomes highly erratic, meaning that an unplanned pregnancy is still very possible until you haven’t had your period for a full year.” This is where a low-dose birth control comes in. Per Goldman, it can be very helpful (and effective), providing peace of mind surrounding contraception, but also leveling out those unpredictable hormone drops that begin to pop up as you move through this decade.

About those hormonal drops: Many women are surprised to learn that birth control offers benefits far beyond preventing pregnancy. Dr. Goldman says the range is vast. “By smoothing the hormonal fluctuations of perimenopause, birth control can help improve a wide range of symptoms like irregular or heavy periods, menstrual pain, hot flashes, night sweats, menstrual migraines, mood changes, sleep disturbances, and premenstrual symptoms, too.”

She was particularly emphatic that birth control can help with heavy and unpredictable bleeding. “Many women assume ‘flooding’ is just something they have to endure in their 40s,” Dr. Goldman explains. “But it can become so severe that they’re changing protection every hour, passing large clots, avoiding travel and social events, or even developing iron deficiency anemia.”

This is where birth control can provide relief. “By keeping the lining of the uterus thin and stable, birth control can dramatically reduce—or even eliminate—this heavy bleeding,” Dr. Goldman says, a result that’s quite life-changing when you consider the fact that they finally feel comfortable leaving the house without worrying about accidents and can sleep through the night again without having to wake-up frequently to swap out a tampon or pad.

Birth control is about more than just preventing pregnancy, it's about finding the option that best fits your health, lifestyle and goals. That’s why, when you discuss it with your OB/GYN or healthcare provider, you want to focus on what you hope birth control will help with, but also whether or not it’s a safe choice for you.

Some important questions to ask, according to Dr. Goldman, are:

• Which birth control method is most appropriate for my age and health history?
• Will it help with the symptoms I’m experiencing?
• What are the potential benefits and side effects?
• How long can I safely use it?
• When and how will I know it’s time to transition off birth control and into menopause management, if needed?

Most healthy women can safely use birth control into their 40s and, in many cases, until menopause. However, some medical conditions may make certain methods less appropriate. “Your clinician will review factors such as whether you smoke—especially if you're over age 35—have high blood pressure, a history of blood clots, stroke, heart disease, migraine with aura, certain liver diseases, or a personal history of breast cancer,” Dr. Goldman explains. “In these situations, another form of contraception—or a non-estrogen-containing option—may be a safer choice.”