Oral contraceptive use seems to decrease a woman’s risk of developing ovarian cancer. However, if a menopausal woman takes the same hormones (estrogen and progesterone), her risk of developing ovarian cancer is NOT reduced. Rather, it seems to increase. Why is this???
Yes oral contraceptives decrease a woman’s risk for ovarian cancer because taking them reduces the number of times an egg is released from the ovaries. A menopausal woman’s ovaries don’t release eggs anymore. If she takes hormones, it is not ovarian cancer that she is at risk for. The estrogen hormone is a contributing factor to risk for breast and endometrial cancers.
Women going through the transitional phase of perimenopause may need help dealing with the body’s reaction to the slightly decreased levels of the ovarian hormone estrogen. Oral contraceptives are increasingly being considered to fulfill this role. Even though the use of oral contraceptives in this way has not been approved by the FDA, it has been scientifically proven that these contraceptives also offer several additional health benefits beyond birth control for the perimenopausal woman. However, just as when used in earlier years of a woman’s life, oral contraception does carry some risks. Be sure to consult a doctor when considering this option for treatment of any perimenopausal symptoms.
Starting Oral Contraceptives for Perimenopause
Unlike regular hormone replacement therapy, there are not well-defined criteria for when a woman can start using oral contraceptives to treat perimenopausal symptoms. If a woman suspects that she has symptoms due to perimenopause that bother her enough to need medication, she can really start whenever she wants. All she needs to do is see her doctor to make sure none of the contraindications apply to her.
Benefits of Oral Contraceptives for Perimenopause
In addition to protecting a woman against unwanted pregnancy, oral contraceptives are also very effective at relieving the annoying symptoms that may be brought about by perimenopause. Some of these symptoms that can be relieved are:
Pre-menstrual syndrome: PMS can sometimes get worse with the onset of perimenopause.
Menstrual cycle irregularity: perimenopausal women will often start to experience an erratic menstrual cycle.
Growing menopausal symptoms: oral contraceptives may relieve minor hot flashes, irritability, insomnia, and any other symptoms common to the beginnings of menopause.
Side-Benefits of Oral Contraceptives
While the main goal of using birth control pills for perimenopausal women is to get rid of certain perimenopausal symptoms, women using these pills can also get some other important health benefits. Some of them are:
A small decrease in bone loss: estrogen prevents the reabsorption of bone while stimulating the release of calcitonin, which maintains bone mass. Therefore, a decline in estrogen levels due to perimenopause results in bone loss, which can lead to osteoporosis and fractures. Supplementing a woman’s body with small extra doses of estrogen can thus slow this harmful process. The best dose to use is 25-35 micrograms of ethinyl estradiol combined with the progestin norethindrone (click here for a list of birth control pills that fit this criteria).
Management of fibroids: some perimenopausal women will develop leiomyomas (tumors made up of smooth muscle tissue) in their uterus. Oral contraceptives may be useful for treatment of these tumors (also called fibroids).
If oral contraceptives are used for long periods of time, they can also play a role in the prevention of endometrial and ovarian cancer. Increasing the amount of time that these pills are taken results in more protection. However, the minimal number of years required to see these positive effects for endometrial cancer is 2 years and for ovarian cancer it is 3. Therefore, if a perimenopausal woman is simply using oral contraceptives for a year to get rid of some of her pesky symptoms, she will not get these benefits. Some good news though is that, as long as she is healthy and does not smoke, oral contraceptive use in perimenopausal women does not increase the risk of having a stroke. Lipid levels are also not negatively affected.
The effect of hormonal supplements on the risk of breast cancer is a topic that has long been debated. It has been shown that oral contraceptives may have a protective effect against the development of breast cancer only for the breast tissue that has no sign of malignancy already. The caveat here is that, if some breast cells have already become malignant, the use of oral contraceptives can actually speed up the development of breast cancer in these cells. But, there is no evidence that it causes those malignancies in the first place.
Special Considerations for Migraine Sufferers
Unlike the average woman, women who experience migraine headaches should think twice about using oral contraceptives during perimenopause. It has been suggested that a history of migraines can increase a womans risk of having a stroke. However, this seems to be limited to women who have an aura before their migraines or who have other neurological symptoms. For this reason, if a woman is considering starting birth control pills for the alleviation of perimenopausal symptoms and is also experiencing migraines, she should be sure to see a neurologist first. He/she will be able to tell whether or not it would be okay to start on the pills.
For women who have migraine headaches that are not associated with neurologic symptoms, a low-dose oral contraceptive can probably be used, but consulting a d