Birth Control for Perimenopause?
Question
I have begun the perimenopause and my Dr. wants me on the pill. He has given me Demulen 135. Why? I have never taken the pill and do not like the idea of messing with the hormones. He wants me to do this because it is easier. Why if my estrogen levels are, as he says, good and in range, would I be prescribed estrogen 135 (he wanted 150). Should I perhaps see another physician? Help, this fellow is not giving me answers I need.
Pam
Answer
Last Updated: June 9, 2013
There has recently been a huge marketing effort by the drug companies to promote birth control pills to perimenopausal women. Unfortunately many physicians have uncritically bought into this trend. There is NO long-term research on this group of women to substantiate the safety of the use of these drugs in this population. It amounts to a giant uncontrolled experiment. You do not mention why your doctor put you on birth control pills. The main reasons birth control pills are promoted to women in their forties is control of bleeding problems and prevention of osteoporosis from declining estrogen levels. There are safer and better ways of achieving these goals without using birth control pills, by the use of bio-identical hormones. Please check out this list of nine reasons why you should avoid birth control pills.
NINE REASONS FOR WOMEN OVER FORTY TO AVOID BIRTH CONTROL PILLS
1. The estrogen in birth control pills may promote breast cancer, especially if used for a prolonged period.
Numerous studies of breast cancer have shown that longer duration of estrogen stimulation and higher dosages of estrogen increase breast cancer. High dosages of estrogen are required to prevent ovulation, the main purpose of birth control pills. Even low-dose pills have double or triple the average amount of estrogen present in a woman’s cycle. The US Department of Health and Human Services placed the ethinyl estradiol in birth control pills on its official list of human carcinogens in December, 2002.
2. The potent artificial estrogen in birth control pills, ethinyl estradiol, comes only in a one-size–fits-all dose.
If estrogen is needed for therapeutic reasons, the bio-identical estrogens, estradiol and estriol, can be given in a range of doses tailored to a woman’s individual needs. The smallest necessary dose given during the part of the cycle in which a woman is deficient in estrogen can give the benefits of estrogen therapy with a lower risk of serious health consequences, as well as fewer side effects of excess estrogen such as breast tenderness, bloating and weight gain. Estriol is the least carcinogenic estrogen.
3. The progestin, the second artificial hormone in birth control pills, can have serious cardiovascular effects.
The second generation-progestins, gestodyne, desogestrel, and norgestimate are associated with an increased incidence of deep-vein thrombosis (DVT). The 3-5% of Caucasian women who carry a particular gene for blood clotting (factor V Leiden mutation) have a 30-50 fold risk of DVT with these preparations. Levonorgestrel and norethindrone, the first-generation progestins derived from testosterone, increase LDL (bad cholesterol) and decrease HDL (good cholesterol). Unlike these artificial hormones, natural progesterone in the luteal phase (last half) of the menstrual cycle can help eliminate abnormal bleeding, as well as improve PMS and sleep, without the serious cardiovascular risks.
4. Birth control pills can cause other serious medical problems.
Glucose intolerance, gall bladder disease and hepatocellular adenoma, and cervical cancer are all promoted by oral contraceptive use.
5. Birth control pills can cause minor health problems and side effects.
Weight gain, depression, and diminished sex drive have all been associated with oral contraceptive use.
6. Birth control pills promote cervical intraepithelial neoplasia (CIN) and are a risk factor for cervical cancer.
The high dose of estrogens in pills cause a larger transformation zone in the cervix, where cell mutations take place. This is an effect independent of and in addition to the other CIN risk factors of HPV (genital wart virus) and multiple sexual partners.
7. Safer and better ways exist to prevent osteoporosis.
Biphosphonates such as Fosamax, or bioidentical estrogen are safer and equally or more effective. Calcium supplements and weight bearing exercise can also have a beneficial impact on bone density.
8. Safer and better ways exist for women to prevent pregnancy.
Non-hormonal methods of fertility control have long been considered the safest methods of fertility control. Modern Natural Family Planning methods have a 97-99% effectiveness rate for preventing pregnancy, and have the additional benefit of obtaining valuable information on a woman’s own estrogen and progesterone levels from monitoring biomarkers during the menstrual cycle.
9. Birth control pills can prevent pregnancy by mechanisms that are destructive to pregnancies that already exist.
Pregnancies occur when breakthrough ovulation takes place, especially when pills are missed. The pregnancy loss occurs typically before a woman has missed a period, before she is aware that she is pregnant. Pills alter the lining of the uterus, preventing implantation of the embryo. Birth control pills also have an adverse effect on ovarian production of progesterone, which helps support pregnancy after ovulation. This means that birth control pills sometimes cause very early abortions, perhaps as frequently as 2%-15% of cycles.
Dr. Mary Davenport
NINE REASONS FOR WOMEN OVER FORTY TO AVOID BIRTH CONTROL PILLS
1. The estrogen in birth control pills may promote breast cancer, especially if used for a prolonged period.
Numerous studies of breast cancer have shown that longer duration of estrogen stimulation and higher dosages of estrogen increase breast cancer. High dosages of estrogen are required to prevent ovulation, the main purpose of birth control pills. Even low-dose pills have double or triple the average amount of estrogen present in a woman’s cycle. The US Department of Health and Human Services placed the ethinyl estradiol in birth control pills on its official list of human carcinogens in December, 2002.
2. The potent artificial estrogen in birth control pills, ethinyl estradiol, comes only in a one-size–fits-all dose.
If estrogen is needed for therapeutic reasons, the bio-identical estrogens, estradiol and estriol, can be given in a range of doses tailored to a woman’s individual needs. The smallest necessary dose given during the part of the cycle in which a woman is deficient in estrogen can give the benefits of estrogen therapy with a lower risk of serious health consequences, as well as fewer side effects of excess estrogen such as breast tenderness, bloating and weight gain. Estriol is the least carcinogenic estrogen.
3. The progestin, the second artificial hormone in birth control pills, can have serious cardiovascular effects.
The second generation-progestins, gestodyne, desogestrel, and norgestimate are associated with an increased incidence of deep-vein thrombosis (DVT). The 3-5% of Caucasian women who carry a particular gene for blood clotting (factor V Leiden mutation) have a 30-50 fold risk of DVT with these preparations. Levonorgestrel and norethindrone, the first-generation progestins derived from testosterone, increase LDL (bad cholesterol) and decrease HDL (good cholesterol). Unlike these artificial hormones, natural progesterone in the luteal phase (last half) of the menstrual cycle can help eliminate abnormal bleeding, as well as improve PMS and sleep, without the serious cardiovascular risks.
4. Birth control pills can cause other serious medical problems.
Glucose intolerance, gall bladder disease and hepatocellular adenoma, and cervical cancer are all promoted by oral contraceptive use.
5. Birth control pills can cause minor health problems and side effects.
Weight gain, depression, and diminished sex drive have all been associated with oral contraceptive use.
6. Birth control pills promote cervical intraepithelial neoplasia (CIN) and are a risk factor for cervical cancer.
The high dose of estrogens in pills cause a larger transformation zone in the cervix, where cell mutations take place. This is an effect independent of and in addition to the other CIN risk factors of HPV (genital wart virus) and multiple sexual partners.
7. Safer and better ways exist to prevent osteoporosis.
Biphosphonates such as Fosamax, or bioidentical estrogen are safer and equally or more effective. Calcium supplements and weight bearing exercise can also have a beneficial impact on bone density.
8. Safer and better ways exist for women to prevent pregnancy.
Non-hormonal methods of fertility control have long been considered the safest methods of fertility control. Modern Natural Family Planning methods have a 97-99% effectiveness rate for preventing pregnancy, and have the additional benefit of obtaining valuable information on a woman’s own estrogen and progesterone levels from monitoring biomarkers during the menstrual cycle.
9. Birth control pills can prevent pregnancy by mechanisms that are destructive to pregnancies that already exist.
Pregnancies occur when breakthrough ovulation takes place, especially when pills are missed. The pregnancy loss occurs typically before a woman has missed a period, before she is aware that she is pregnant. Pills alter the lining of the uterus, preventing implantation of the embryo. Birth control pills also have an adverse effect on ovarian production of progesterone, which helps support pregnancy after ovulation. This means that birth control pills sometimes cause very early abortions, perhaps as frequently as 2%-15% of cycles.
Dr. Mary Davenport
Answered By:
Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over MyCatholicDoctor.com She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.
