I’m pretty sure I’m in perimenopause based on a number of disruptive symptoms, and I went to my OB-GYN appointment armed with your “how to talk to your doctor about HRT” script. She said that the estrogen patches commonly prescribed during menopause actually have less estrogen than the birth control I’m on (the Nuva ring) and that I’m essentially already getting HRT. I’m wondering if all forms of estrogen are the same, and if this means I’m just stuck with the symptoms that I’m experiencing.
—Anonymous
In general, it is true that combination hormonal contraception containing estrogen and progestin contains higher levels of estrogen than estrogen-containing products formulated for treating perimenopausal symptoms. This is because the goal of most hormonal contraception is to suppress ovulation, and the goal of hormone therapy is to provide a stable dose of estrogen just high enough to manage the symptoms of perimenopause.
However, of all the forms of combined hormonal contraceptives — the ring, the patch, and pills — the ring results in the lowest blood levels of estrogen. Additionally, the level of estrogen in the blood slowly increases for the first week the ring is in place and then slowly decreases over the next two weeks. Compare that with a combination birth control pill or even an estradiol patch, where blood levels of estrogen will be roughly stable from day to day (except, of course, when taking the sugar pills in a birth control pack).
So on one hand, your gynecologist is correct that your ring contains more estrogen than a typical hormone therapy regimen. On the other hand, the ring is not providing you with a stable blood level of estrogen, which may be part of the reason you are having symptoms.
If you are unhappy with your symptom management, it may be worth exploring other formulations. You do not need to live with your symptoms. In women who need contraception — I assume you are using the ring to prevent pregnancy — switching to a birth control pill may be a good option to both avoid unwanted pregnancy and manage your perimenopausal symptoms. Another alternative would be to have a progestin-eluting IUD placed for contraception and, as a source of progesterone to protect your uterine lining, add an estrogen patch.
The upshot: Combined hormonal contraception does contain higher doses of estrogen than estrogen formulated to manage perimenopausal symptoms. However, you may achieve better symptom management with another formulation of combined hormonal contraception.
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