Transcript
Dr. Jill Liss: Hi, I am Dr. Jill Liss, board-certified OB-GYN, Menopause Society Certified Practitioner, and an advisor to Versalie. Today we're going to talk about pregnancy and perimenopause, a topic that's commonly misunderstood and incredibly important. Let's jump into your questions.
Ambassador: What are the chances of getting pregnant during perimenopause?
Dr. Liss: Perimenopause is the phase leading up to the final menstrual period. For most people, this transition is about four to eight years. Over the course of someone's 40s, fertility does significantly decline. However, as long as someone's still menstruating and ovulating, pregnancy is possible.
Women over 40 represent one of the largest groups of people with unintended pregnancies. So, if pregnancy is not part of your plan, it's important to consider your contraceptive options.
Ambassador: Can I stop birth control during perimenopause?
Dr. Liss: Stopping birth control during perimenopause can be considered for various personal reasons. However, it's not advised if you're not desiring to become pregnant and there's not a backup plan in place. Periods do become more irregular, so tactics like tracking your cycle and using natural family planning methods become less reliable.
So if you're still having periods, even if they are irregular and don't desire to become pregnant, it’s really important to consider contraceptive options. Talk to your doctor about any changes to your contraceptive plans.
Ambassador: What are some birth control options during perimenopause?
Dr. Liss: Birth control options in perimenopause will depend heavily on the individual and their personal risk factors. But generally speaking, all forms of contraceptives that people may have used throughout their reproductive life course are typically still on the table.
So there are hormonal options, which include things like oral contraceptive pills, vaginal ring, patch, as well as a hormonal IUD. And there are non-hormonal options, including things like natural family planning, condoms, or other barrier methods, as well as the copper IUD. There are a few methods that tend to work well in perimenopause because they can treat perimenopause-related symptoms, as well as provide contraception.
Some methods that I use a lot in my practice include the hormonal IUD, which can really help with abnormal or heavy bleeding, as well as provide contraception. Hormonal birth control pills that have both an estrogen and a progestin may also be effective in treating both perimenopause symptoms, as well as providing contraception. Talk to your doctor about what options would be right and safe for you.
Ambassador: Does hormonal birth control affect perimenopause symptoms?
Dr. Liss: This is such a great question because hormonal birth control can be a really powerful tool for managing perimenopause symptoms as well as providing reliable contraception. Hormonal birth control can help with perimenopause symptoms like hot flashes, trouble sleeping, some breast tenderness, and even irregular bleeding. All of these things together represent symptoms of both hormone excess as well as low hormones.
We need a tool that can both relieve symptoms of when the hormones are too high, as well as when they're too low. So finding something that keeps you stable in the middle can be the optimal choice for managing symptoms. Hormonal birth control does this by suppressing the ovary and telling it not to ovulate while also putting back the hormones.
Ambassador: Is natural planning a reliable method to prevent pregnancy during perimenopause?
Dr. Liss: Natural family planning is a contraceptive technique where someone tracks their cycle closely and pays attention to their fertile window. This is a great technique for people who have regular menstrual cycles and are motivated to follow them closely.
The problem is, as perimenopause progresses, this ovulation can become even more erratic month to month and over years, such that preventing pregnancy in this way is not reliable. If preventing pregnancy is your goal, this would not be the most recommended or reliable form of contraception in perimenopause.
Ambassador: So I know there are hormonal versus non-hormonal methods of birth control. For someone approaching menopause, what are the benefits or potential side effects or risks of one versus the other?
Dr. Liss: Both hormonal and non-hormonal birth control methods have risks and benefits. For most people, the benefits far outweigh the risks. Hormonal contraceptive options can be great for many people because they're both highly effective as contraception and may double in treating perimenopause symptoms, things like hot flashes and abnormal bleeding.
Non-hormonal methods are great for people who need to avoid or would like to avoid hormones. However, they don't have the added benefit of treating perimenopause symptoms at the same time. Risks and benefits depend highly on your personal health history. Your doctor is the best person to help you weigh these pros and cons.
Perimenopause presents a unique challenge. You're both winding down your reproductive years, but also still at risk of pregnancy. Preventing pregnancy in perimenopause requires understanding your body and your options and making sure your priorities are set.
There are many options, both hormonal contraception and other that can provide great relief of perimenopause symptoms while also preventing pregnancy. Talk to your doctor about what's right for you.