Yes, you read that correctly. I recently started taking birth control pills at 49. I don’t need to prevent pregnancy. My husband has had a vasectomy. Twice. What I do need is some reprieve from a menstrual cycle that has become demonic.
I was recently diagnosed with premenstrual dysphoric disorder (PMDD) and my doctor prescribed a birth control pill to treat my symptoms. You can read about my PMDD diagnosis and symptoms here. The pill used to treat PMDD is made with drospirenone (a 4th generation progestin) and ethinyl estradiol. The brand name Yaz is the low dose birth control pill that is approved by the FDA to treat PMDD.
What Is Low Dose Birth Control?
Low-dose birth control is a type of hormonal birth control that contains lower amounts of hormones than some older, traditional pills.
Low-dose birth control pills come in combination pills and progestin-only pills, which are also referred to as minipills. Combination pills use both estrogen and progestin, where low-dose combination birth control pills provide lower doses of estrogen than traditional pills. Minipills contain progestin and no estrogen.
How It Went With The Low Dose Birth Control
I stopped the compounded oral micronized progesterone I had been taking to promote sleep, help with mood swings, and stop cystic acne related to my menstrual cycle. I also stopped the vaginal estrogen I had started taking due to the sudden onset of some intense symptoms related to genitourinary syndrome of menopause (GSM). A few days later, I stared at the package of little pills – so small and yet so powerful. Crossing my fingers, I said: ‘I hope this works’.
The Birth Control Pills Made Me Miserable
On day 5 after starting the birth control pills I was having a bath before bed. The kids were asleep. Now relaxed after a long day, I was about to dry off when I suddenly started to cry. Despite willing these pills to work, the truth is that the day I started taking the birth control pills I started to feel off. I so wanted these pills to be the solution, but instead they were making me feel horrible.
A Shell Of A Human
My husband came into the bathroom. Crying, I said ‘I don’t think I can take these birth control pills anymore.’ And with relief my husband said, ‘I agree. You can’t keep taking those pills. They may stop the pain, but you are a shell of a human being right now – anxious, emotional, withdrawn – you are not yourself.’
If No Birth Control Pills Then What?
I called my doctor’s office the next morning and booked an appointment. I was honest about how I was feeling and my doctor agreed that continuing to take the medication, as sometimes side effects will subside, was not appropriate in this instance. So now what do I do?
My doctor explained that in the past she has seen a difference in compounded vs pharmaceutical products, and she suggested that I try a commercially prepared (or pharmaceutical) oral micronized progesterone instead of a compounded progesterone to stop my periods. I agreed.
Low And Slow
I started with 100 mg of Teva-Progesterone, a generic version of Prometrium, which is the pharmaceutical brand-name progesterone. I had some bloating and stomach upset in the first few days. My doctor said if I could tolerate the side effects, that I should try to continue to see if the side effects subside. If not, she could request that the pharmacy cut the pills in half and I could try a lower dose.
I decided to continue at 100 mg and after a few more days the bloating and stomach upset stopped. A week later I had some bleeding that lasted a few days, and I increased the dose to 200 mg.
No Period – No Pain – Good Sleep – Good Mood
Six months later I had not had a period or menstrual pain. I had only one night where I couldn’t get back to sleep after waking at 2 am. And I felt better than I had in years.
Recently I did get my period and while I had some PMS symptoms, including mood swings and crying spells, the symptoms were fairly mild. The bleeding however was quite heavy and after 7 days, I increased the dose of progesterone to 300 mg, which is the prescribed dose. That stopped the bleeding and I don’t seem to have any side effects. Fingers crossed.
Can Birth Control Pills Help With Perimenopause Symptoms?
The birth control pill can even out the dips and peaks of fluctuating hormones in perimenopause and provide symptom relief. It can take some trial and error to find the right pill. As with any medication, speak to your doctor about the risks and benefits, and whether the birth control pill, and what type might, be right for you.
Are Birth Control Pills Safe?
As with any medication or supplement, there are always risks. That said, the risks associated with low dose birth control pills are lower than with older formulations.
Most data show that your overall risk of cancer does not increase when taking birth control pills. There is still some debate when it comes to breast cancer, as some studies show a slight increase in breast cancer risk. And the birth control pill may decrease your risk of certain cancers like endometrial, ovarian, and colon.
Other considerations include the fact that birth control pills may slightly increase your blood pressure and can also impact your cholesterol levels. Changes to your cholesterol are generally not significant and can be beneficial when you are taking birth control pills with more estrogen.
Pills containing estrogen are not advised for those at risk of cardiovascular disease or hypertension or for those who smoke, particularly over the age of 35. Speak to your doctor about your specific risk profile and what options may be right for you.
Again, it is important to speak to your doctor about benefits and risks associated with any medication. You can also speak with your pharmacist as they are medication management experts and often have more time to review the details of a medication. Pharmacists can help with providing more in-depth explanations or review things you may have forgotten or not fully understood.
How Will You Know If You Have Achieved Menopause?
A woman on combination birth control pills may not know she’s completed the transition to menopause because the pills can mask menopause symptoms as well as cause withdrawal bleeds during the sugar-pill week. So you may still bleed even though you have actually achieved menopause. You may also be prescribed a regimen, where you skip the sugar pills to keep your period from happening.
You will also want to get advice from your doctor about how to determine when you have achieved menopause if you are taking birth control pills. The average age of menopause is 51.5 years in Canada. Seeking medical advice about whether continuing with hormone replacement therapy (also known as menopause hormone therapy) might be right for you once you have stopped taking birth control pills is also something you should consider.
Pregnancy and Perimenopause?
If you are still having periods, irregular or otherwise, you can still get pregnant. In fact, perimenopausal women have the second highest rate of unintended pregnancy after teenagers. So if you are still having a period and are sexually active, be sure you are using birth control.
If the pill is not right for you, an IUD that releases progestin may be a good option for both birth control and managing heavy bleeding. An IUD that releases progestin also offers uterine protection and can be used instead of an oral progestin/progesterone if you are taking estrogen to manage symptoms like hot flashes.
And Don’t Forget About STDs
It’s also important to note that rates of sexually transmitted diseases (STDs) for those over 50 years of age are on the rise. Condoms are the only way to protect against STDs if you are sexually active.
The Hero Bit
One of the most important things you can do is be prepared for your medical appointments. I have a tendency to downplay my symptoms when speaking to a medical practitioner, especially if they aren’t happening during the appointment. Sometimes it’s because my perimenopause brain has kicked in and I truly forget to mention something. Other times I am dismissive of my own symptoms so as not to appear weak or like I am complaining.
I now write down my symptoms and the points I need to cover with my doctor so that I am providing an accurate description of what has been going on with my body. Your care team is only as good as the information you provide.