Choosing between hormone replacement therapy (HRT) and birth control pills for perimenopause may depend on medical history, risk factors, age, and symptom severity.
HRT and birth control pills may help manage perimenopausal symptoms and protect bone health. This article compares the benefits and risks of HRT and birth control pills for perimenopause.
| HRT | Birth control pills | |
|---|---|---|
| Benefits for perimenopause | • relieves menopausal symptoms • protects against bone loss • reduces risk of osteoporosis | • relieves menopausal symptoms • protects bone mineral density • protects against some cancers |
| Risks and side effects | • small increased risk of breast cancer • heart attack • deep vein thrombosis • gallbladder disease | • increased risk of breast cancer • venous thromboembolism • heart attack (rare) |
| How to use | • take daily to manage symptoms, and discuss with a doctor when to stop taking | • take until menopause |
Certain factors are important to consider when choosing between HRT and birth control pills, including:
- personal and family medical history, such as history of estrogen-based cancers
- any health risks, such as smoking or obesity
- age
- symptom severity
Benefits of HRT for perimenopause include:
- relieves symptoms such as hot flashes, night sweats, and vaginal dryness
- protects against menopause-related bone loss and reduces the risk of osteoporosis and fractures
- combined HRT may reduce colon cancer risk
Side effects of HRT
- abnormal bleeding from the uterus
- nausea
- mood changes
- fluid retention
- headaches
- breast tenderness
- bloating
Risks of HRT include:
- small increased risk of breast cancer with combined HRT
- small increased risk of heart attack in older females, although this is rare
- deep vein thrombosis with combined or estrogen-only HRT
- small increased risk of gallbladder disease
The combined pill may not be safe for people who:
- smoke
- have obesity
- have atypical blood pressure
- have cardiovascular disease
Learn more about the uses, types, and effects of HRT.
Benefits of the combined pill for perimenopause include:
- relieves symptoms such as irregular and heavy periods, hot flashes, menstrual pain, and night sweats
- reduces the risk of endometrial cancer, colorectal cancer, and ovarian cancer
- protects and maintains bone mineral density
Side effects of birth control pills may include:
- spotting or bleeding between periods
- nausea
- headaches
- sore breasts
Risks of birth control pills include:
- breast cancer
- venous thromboembolism
- heart attack, although these events are rare
It is important for people with a uterus to take estrogen alongside progestogen. The addition of progestogen
People may treat perimenopause symptoms by taking HRT in the form of:
- pills
- patches
- gels
- sprays
- vaginal creams, tablets, or rings, which only target vaginal dryness
People will take estrogen-only HRT daily. If they are taking estrogen and progestogen, they may take both daily or estrogen daily, adding progestogen 10 to 14 days each month.
People may take birth control pills for symptoms of perimenopause until they reach menopause.
A doctor may advise taking the pill until the age of 50 years, and then switching to HRT. A doctor may suggest people take oral contraceptives continuously rather than cyclically with a break.
People ages 40 and above will need to check with a doctor that they are safe to take combined oral contraceptives for perimenopause, as they can increase the risk of certain health conditions.
Complementary and alternative therapies for perimenopause symptoms
- black cohosh
- red clover
- soy products
- acupuncture
- yoga and tai chi
- hypnosis
Some people may experience symptom relief with alternative treatments for perimenopause, but further research is necessary to better understand their safety and effectiveness.
Some natural remedies, such as red clover and soy, may not be safe for people who cannot take estrogen-based hormone therapy. It is important to discuss any supplements with a doctor before taking them for perimenopause.
Learn more about supplements for menopause.
Doctors will assess a person’s individual situation to determine the most appropriate treatment option. This includes assessing factors such as:
- personal and family medical history
- health risks
- age
- symptom severity
Can HRT and birth control pills be used together during perimenopause?
People cannot use HRT alongside birth control pills containing estrogen, such as the combined pill. People can generally take progestogen-only pills with HRT.
How do HRT and birth control pills affect bone health during perimenopause?
Taking the combined pill in a person’s 40s may help protect bone mineral density. Taking the combined pill 6 years before menopause may increase bone mineral density in some areas of the body, and help reduce the risk of postmenopausal hip fractures.
Systemic estrogen therapy helps to protect against bone loss, which can happen in the early stages of menopause, and helps prevent osteoporosis.
Research suggests bone tissue may start to break down in the transition to menopause, not after menopause. Further research is necessary to know the most effective time to start estrogen therapy to help prevent menopause-related bone loss.
How long can someone safely use birth control pills during perimenopause?
People may take the combined pill until they reach menopause. Estrogen doses in birth control pills are significantly higher than those in HRT for menopause, which may increase health risks. A doctor may recommend switching to HRT at menopause or the age of 50.
People can talk with a doctor to decide whether HRT or birth control pills are best for perimenopause. Factors to consider include medical history, risk factors, age, and symptom severity.
