You have kept busy all life at work as well as home. Now, as your children are becoming independent, you thought it was going to be a relaxing experience. Little did you imagine that you will face not one but many health problems. Suddenly you feel hot while the others don’t and it is quite cold outside. You cannot sleep well and are woken up by vivid dreams that leave you sweating. You get irritable and depressed. Worst of all, you started having heavy bleeding very frequently. You now decided to see a doctor who has told you that menopause is approaching and has advised birth control pills. You get anxious further as you were explained that the pills were too in dose to cause any untoward effects on your health. You are willing to know more about the benefits, risks, dosing, and side effects of these pills.
Understanding perimenopause
Perimenopause is the phase of transition of a woman of child bearing age to cessation of menstruation and fertility. Perimenopause usually begins around 45 to 55 years of age, but in some it may set in early, even at around 35 years of age. As menopause approaches, there may be some tell tale signs. A common problem during this transition is an irregular menstrual bleeding. The cycles may become frequent or infrequent as compared to the past ones. In addition, the bleeding in each episode may be heavier or lighter than before. Most women also experience hot flashes. These are felt like a sudden rush of heat. Women may awaken from sleep to find themselves drenched in sweat. There may be sleep irregularities and disturbances. The birth canal may feel dry and hair may get thin and frail. There may be growth of facial hair. There may be irritability and mood swings. Bones get weak and more liable to fractures. These changes occur due to the dwindling levels of hormones in the body as the gonads, called ovaries, get erratic in producing eggs. This is not a disease. It is a natural transition.
Perimenopause and very low dose birth control pills
Birth control pills have two types of hormones, estrogen and progestin. The amount of estrogen they contain makes them high, low, or very low dose pills. Very low dose pills have 20 mcg of estrogen plus progestin; low dose pills have 30 to 35 mcg of estrogen plus progestin; and high dose pills have about 50 mcg of estrogen plus progestin.
The very-low-dose birth control pills are prescribed during perimenopause. These offer manifold benefits. These pills prevent an undesired pregnancy during this phase of transition. They act as cycle regulators as these help to restore the near normal levels of hormones. The irregular and heavy or light bleeding episodes are corrected. They prevent formation of cysts in ovaries and keep hormone levels under check. Hot flashes are relieved and normal sleep patterns are restored. The bones gradually regain strength and density. Risk of fractures may be reduced. These pills are also known to offer some protection against ovarian cancer and that of the uterus (womb). Mood swings, depression, and irritability are reduced and there is a sense of wellbeing.
The very low dose pills are initiated at specific times in the menstrual cycle to match the natural patterns of hormone changes. These may be initiated either on the first day of a menstrual period or on the first Sunday after a period begins. The pills are taken for 21 days. Then for 1 week there is a gap during which dummy pills called placebo is given. The pills should be taken daily for best results. If one forgets to take a pill, then one should take it as soon as one remembers it. The next pill may be taken as usual. However, if 2 or more pills are missed during a cycle, an additional contraception precaution should be taken for the cycle if the woman is sexually active. The next cycle must then be presumed as usual.
Very low dose birth control pills are not for everyone
Not all women may deem fit for the very low dose birth control pills. These pills are not safe in women who smoke, as there may be an increased risk of circulatory and heart problems that can even lead to a heart attack. The pills are not safe for women who have a tendency or history of deep vein thrombosis, a condition in which blood clots in the vessels of calves and the clots may subsequent dislodge to block blood supply to one of the vital organs like the brain or lung. If the cause of the genital bleeding is not determined or the behavior of bleeding suspected to be due to a cancer of the genital tract, it is best to keep away from any kind of hormonal contraceptive pills. Many tumors like those of the breast are said to be estrogen dependent and even express markers for the same. If a woman has another family member diagnosed breast cancer, or is otherwise at risk of one, it is not good to use hormonal contraceptive pills. These should be prescribed with caution in hypertension and migraine. These should be avoided in liver disease, diabetes, and high cholesterol.
Side effects
The very low dose birth control pills offer several advantages but are not devoid of adverse effects. The adverse effects may vary in type and intensity from woman to woman. Some unwanted effects may subside after a few days. Women may experience a feeling of headaches, vomiting or pain the breasts. Some tend to gain weight. Others may develop a high blood pressure, heart problems, and tendency to form clots in blood. In some, there may be a heightened possibility of cancer of the cervix, the lower part of the womb that opens into the birth canal. An episode of bleeding may occur in the last week of dosing. This is called the ‘breakthrough’ bleeding.
Menopause when taking birth control pills
Perimenopause is a sign of a gradually approaching menopause. Menopause is said to have set in when there is a continuous absence of menstruation for a period of 12 consecutive months after the last period. It is thus a diagnosis made in retrospect depending upon recollection of date of the last period. To determine if menopause has actually set in, a blood test may be done. The levels of the follicle stimulating hormone (FSH) are measured on the last day of the placebo week. If these levels are more than 30mIU/mL, it is suggestive of menopause and the doctor may advise a change from very-low-dose pills to hormone replacement therapy (HRT). Alternatively, the pills may be discontinued for 2 weeks and then a blood test done to measure levels of estradiol. Both FSH and estradiol may be measured together. Many doctors presume menopause to have set in by 52 to 54 years of age and make a switch in therapy.
Approaching menopause with a positive mind
Perimenopause is not a disease; it is a natural transition from one stage of life to another. Unfortunately, this transition may not be a pleasurable experience due to changes in hormone levels. Very-low-dose birth control pills can be a woman’s best friend in the phase of transition to menopause. They can make menopause a more natural and physiological experience!
