Several newsletters lately have referred to birth control only being safe until age 51. But if we don’t know if we’re peri/menopausal because we’re on birth control, thus don’t know what symptoms we’re masking (if any), what happens at 51? What should I be discussing as options with my doctor? Do I really just have to play it by ear for months and experience symptoms to know what to do next?
—Almost 51
The source of this cutoff for using birth control pills is somewhat historical. When the pills first came on the market in the 1960s and for several decades after that, it was recommended that women not take them after age 35. The concern was that the risk of blood clots increased after age 35 to the point where the benefits of the pill were outweighed by the risk of blood clots. However, early birth control pills contained 5 to 15 times the estrogen that modern birth control pills contain. Plus, many women in the 1960s and 1970s smoked, and we know that smoking cigarettes increases the risk for blood clots.
Today’s birth control pills contain just a fraction of the estrogen of the first pills, and many fewer women smoke today; as a result, the revised guidance suggests that birth control pills are safe for most women until the “average age of menopause.” The average age of menopause is technically 51.4 years.
Does that mean on the 146th day of your 52nd year, you need to stop the pill? That is not my interpretation of recommendations. This gets a bit into the art of practicing medicine. Different doctors will have different approaches for managing what comes next.
I typically approach the transition off birth control pills in two possible ways. Option one is to transition straight from birth control pills to combination hormone therapy such as an estrogen patch and oral progesterone. The benefit of that option is that it minimizes the likelihood that you will have perimenopausal symptoms. The downside is that if you are still perimenopausal, you could experience some breakthrough bleeding.
The second approach I will take is to stop birth control pills for a month or two. If a woman’s periods resume, we restart the pill. If she feels great, we do nothing. If she has perimenopausal symptoms but no periods, we can start hormone therapy. The benefit of this plan is you are taking a moment to take stock of your symptoms and develop a new plan. The downside is that you may be symptomatic temporarily as the next best steps are determined.
I determine which approach to take by discussing both options with my patient and considering which plan they prefer. There is no right or wrong answer.
The upshot: Birth control pills are considered safe until the average age of menopause, but that does not mean you need to stop taking them the moment you turn 51. There are many ways to transition off birth control pills while minimizing perimenopausal symptoms when the time comes.
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