Finding relief from perimenopause symptoms is possible, and you can do it, too. Here’s your go-to guide to HRT and birth control for perimenopause, to help you choose between these two common treatment options.
Perimenopause can be painful and distressing, there’s no denying that. Millions of women are plagued by physical and emotional symptoms , like hot flashes, vaginal dryness, sleep disturbances, and more.
But you don’t have to suffer in silence. Treatments like hormone replacement therapy (HRT) and certain birth control methods offer relief from symptoms, so you can ease your transition into menopause.
Let’s take a look at HRT and birth control for perimenopause, to help you decide which treatment could be right for you.
Why do I have perimenopause symptoms?
Perimenopause is driven by major changes in your body’s production of key reproductive hormones. Estrogen and progesterone levels, for example, decline over time.
But hormones don’t change steadily: instead, levels fluctuate unpredictably, knocking your hormones out of balance with one another. This can cause a variety of symptoms.
Common perimenopause symptoms include:
Irregular periods Hot flashes (vasomotor symptoms) Mood changes Trouble sleeping Vaginal dryness Luckily, perimenopause treatments can help you manage symptoms as you move through the menopausal transition.
Does hormone replacement therapy help with perimenopause symptoms?
Yes, hormone replacement therapy (HRT) can offer relief from perimenopause symptoms. HRT is sometimes also called menopausal hormone therapy (MHT) or hormone therapy (HT).
HRT medication replicates estrogen and progesterone, treating perimenopause symptoms by adding these hormones back into your system. This supplements your body’s hormone production, stabilizes declining levels, and eases fluctuations, helping you manage symptoms like hot flashes, night sweats, sleep disturbances, and vaginal symptoms [1].
What are the types of HRT for perimenopause?
There are two main types of HRT:
Estrogen-only therapy : Contains estrogen only, and can be used by those who’ve had their uterus removed (a hysterectomy).Combined therapy : Contains estrogen and progestogen (a type of synthetic progesterone), and can be used by those who still have a uterus.Both estrogen-only HRT and combined HRT are available in these forms:
Pill Patch Gel Spray Injection Gels, sprays, and injections generally only administer estrogen. If you use one of these methods for combined HRT, your treatment will also include a progestogen pill or progestogen intrauterine device (IUD).
These five HRT methods are all “systemic,” meaning they release hormones into your bloodstream. Other forms of HRT are “nonsystemic,” meaning hormones don’t enter your bloodstream.
Vaginal estrogen HRT, for example, releases estrogen locally into the vagina only, using a tablet, cream, gel, or ring inserted into the vagina. Vaginal estrogen HRT doesn’t need to be supplemented with progestogen [2].
What is bioidentical HRT?
Bioidentical HRT , sometimes also called regulated body-identical hormone therapy (rBHT), is another type of hormone therapy.
Bioidentical HRT works like conventional HRT, except it uses hormones derived from plants whereas conventional HRT uses animal-derived hormones (although both types share certain hormones, too) [3,4]. Both are safe perimenopause treatments.
But watch out: compounded bioidentical HRT is different. This product isn’t FDA-approved or FDA-regulated, meaning it isn’t safe [5].
Who can use HRT for perimenopause?
HRT may be the right treatment for your perimenopause symptoms if you meet the following conditions:
You’re 59 or younger You started perimenopause less than ten years ago You aren’t at high risk of breast cancer, blood clots, or stroke If you’re treating vaginal symptoms only, health experts recommend trying vaginal estrogen HRT before combined HRT [6].
Does the pill help with perimenopause symptoms?
Yes, certain hormonal birth control methods can also treat perimenopause symptoms.
What birth control methods can you use for perimenopause?
The combined oral contraceptive pill (commonly called the pill) and the hormonal IUD can both help with perimenopause.
These hormonal contraceptives treat perimenopause symptoms by releasing hormones into your body to regulate hormone levels – similar to the way HRT works. These methods help you manage symptoms like cycle irregularity, premenstrual pain, and hot flashes [7].
A perimenopause prescription for the pill likely won’t include the typical week of placebo pills, as temporarily stopping medication during the no-pill week can make symptoms come back [8]. An IUD automatically provides a steady stream of hormones.
Who can use the pill for perimenopause?
Hormonal contraceptives may be right for managing your perimenopause symptoms if:
You want to avoid pregnancy You’re younger than 50 (some doctors recommend switching to HRT after 50) [9] You aren’t at high risk of diabetes or heart disease You have normal blood pressure Can you combine the pill and HRT?
No, you can’t take the pill and HRT at the same time. However, taking HRT alongside the progestogen-only pill (commonly called the mini pill) is usually possible [9]. Using an IUD while taking HRT is also possible. In fact, many people use an IUD as part of combined HRT.
Benefits and risks of HRT or the pill for perimenopause
To help you decide which perimenopause treatment is right for you, let’s take a look at their benefits and risks.
What are the benefits of HRT for perimenopause?
HRT can help you treat perimenopause symptoms like [1]:
Hot flashes Night sweats Trouble sleeping Mood symptoms Vaginal symptoms, including dryness, irritation, and pain during sex (dyspareunia) HRT also helps prevent bone loss and reduce the risk of fractures [1]. This is good news, since bone loss speeds up significantly during perimenopause [10]. Plus, HRT may help lower the risk of heart disease and diabetes [11].
What are the risks of HRT for perimenopause?
HRT is a safe and effective perimenopause treatment, but like any medication, it comes with risks. Overall risk is low. Risks include:
Stroke Blood clots Breast cancer Vaginal estrogen HRT doesn’t increase the risk of these conditions. Estrogen-only patches, gels, sprays, and low-dose pills may have a lower risk of blood clots and stroke [1].
What are the benefits of the pill for perimenopause?
The pill and hormonal IUD can help you manage perimenopause symptoms like [7]:
Irregular periods Heavy periods Premenstrual symptoms, including headaches and period pain Hot flashes Night sweats The pill may also help lower the risk of certain types of cancer, including ovarian, endometrial, and colorectal cancer [7].
Pregnancy is another key consideration. Contrary to popular belief, getting pregnant during perimenopause is possible . Hormonal contraceptives both protect against pregnancy and provide perimenopause symptom relief, perfect for those who want to avoid conceiving.
What are the risks of the pill for perimenopause?
The pill also comes with risks. Risks are low, and include:
Breast cancer Blood clots Heart attack Compared to the pill, IUDs have a lower risk of blood clots and may have fewer side effects. The risk of breast cancer may also be lower, but more research is needed [12].
How to choose between HRT or the pill for perimenopause
The right perimenopause treatment for you depends on your medical history and your symptoms. Your doctor can help you determine which treatment is safest and likely to be most helpful for your unique needs.
Your treatment goals may also help you choose between HRT or the pill for perimenopause. For example:
Do you have unbearable hot flashes? Consider HRT , the most effective treatment for hot flashes [1]. Do you have painful and distressing vaginal symptoms, like dryness and irritation? Try vaginal estrogen HRT . Do you want to avoid pregnancy while managing perimenopause symptoms? Use a hormonal contraceptive . Outside of medical treatments, lifestyle strategies may help with perimenopause, too. Aim to eat a balanced diet, exercise regularly, reduce stress, and keep a regular sleep schedule. Acupuncture may also offer relief.
HRT vs Birth Control for Perimenopause: The bottom line
HRT and birth control are two great options for finding relief from perimenopause symptoms. Both treatments help regulate your hormones, stabilizing fluctuations to manage perimenopause.
Talk to your doctor about whether HRT or the pill for perimenopause could be right for you. With support, you can transform your perimenopause journey from a bumpy ride into a smooth sail.
