Dr. MJ Bazos MD, Patient Handout
Very-Low-Dose Birth Control Pills for Perimenopausal Women

What are very-low-dose birth control pills?

Very-low-dose birth control pills (brand names: Estrin 1/20, Alesse) have less estrogen than regular birth control pills. These pills have 20 micrograms of estrogen, compared with 30 to 50 micrograms in regular birth control pills.

What does perimenopause mean?

When your periods stop completely, it's called menopause. Perimenopause means "around the time of menopause." The perimenopausal years are the few years before your periods stop. The timing of menopause is different for each woman. Although some women stop having periods in their 30s, the average age is the early 50s. So, perimenopausal women are usually in their 40s or early 50s.

Why would I use very-low-dose birth control pills during perimenopause?

If you're still having periods, you could still get pregnant. Very-low-dose birth control pills prevent pregnancy and may also have some health benefits. They can help regulate your periods if they are heavy or irregular. They may also prevent bone loss, which helps protect you from osteoporosis. Another potential benefit is protection from cancer of the ovary and uterus. The lower dose of estrogen in these pills (compared to regular birth control pills) is believed to be safer for women who are perimenopausal.

Who shouldn't take very-low-dose birth control pills?

Perimenopausal women who have a history of deep blood clots, breast cancer or heart disease should not take very-low-dose birth control pills. Perimenopausal women who smoke probably should not take them, either.

How are very-low-dose birth control pills taken?

Very-low-dose birth control pills are taken the same way as other birth control pills. They are usually started on the first Sunday after your period starts. If you're perimenopausal but you aren't having regular periods, you can probably take a hormone called medroxyprogesterone acetate (brand name: Provera) to start your period. (Your doctor will check you for pregnancy first.)

These pills are taken for 21 days in a row and then not taken for 7 days. During the 7 days without medicine, your period will start. Seven days later (this will be on a Sunday), you'll start taking the very-low-dose birth control pills for another cycle.

Do very-low-dose birth control pills have any side effects?

The hormone doses in these pills are so low that most women don't have side effects. You might have breast tenderness, nausea, higher blood pressure or headaches. It's also possible that these very-low-dose birth control pills may not regulate your periods. If you're having any abnormal bleeding, it might get worse. There may be some risk that estrogen increases the risk of breast cancer, but this hasn't been proved.

If I'm taking birth control pills, how will I know when menopause starts?

You and your doctor will decide together how long you should take this medicine. You can stop taking very-low-dose birth control pills any time, or you can change to regular estrogen replacement therapy. The decision to change from the low-dose birth control pills to estrogen replacement therapy is usually made around the age of 49 to 52. Your doctor can also measure a hormone called FSH (follicle-stimulating hormone) to see if you're in menopause. If the FSH measurement is over 30, you've probably entered menopause.

Talk to your doctor to see if very-low-dose birth control pills might be a good idea for you during your perimenopausal years.