Oct 15, 1998 Table of Contents

Please note: This information was current at the time of publication. But medical information is always changing, and some information given here may be out of date. For regularly updated information on a variety of health topics, please visit familydoctor.org, the AAFP patient education Web site.

Information from Your Family Doctor

Very-Low-Dose Birth Control Pills in Mid-Life (Perimenopause)

Am Fam Physician. 1998 Oct 15;58(6):1381-1382.

See related article on oral contraceptive use during the perimenopausal years.

What are very-low-dose birth control pills?

Very-low-dose birth control pills (brand names: Estrin 1/20, Alesse) are also called oral contraceptives. They 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. Even regular birth control pills today contain much less estrogen than they used to in the 1970s, when pills had about 100 micrograms of estrogen. This lower dose of estrogen is believed to be safer for women who are perimenopausal.

What does perimenopause mean?

When your periods stop completely, it's called menopause. Perimenopause means “around the time of menopause.” The peri-menopausal 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, peri-menopausal women are usually in their 40s or early 50s.

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

Very-low-dose birth control pills not only prevent pregnancy but may also have some health benefits. If you're in your 40s and are still having periods, you could still get pregnant. Very-low-dose birth control pills protect you from pregnancy. They can help regulate your periods if they are heavy or irregular. Very-low-dose birth control pills also may prevent bone loss, which helps protect you from osteoporosis. Another potential benefit is protection from cancer of the ovary and uterus.

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 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 seven days. During the seven days without medicine, your period will start. Seven days later (this will be on a Sunday), you'll start taking the very-low-dose oral contraceptives for another cycle (21 days on the hormone pills, seven days off).

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 ages 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 oral contraceptives might be a good idea for you during your perimenopausal years.


This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Copyright © 1998 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

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