To Pill or Not to Pill, that is my question

January 6, 2012 4:26 PM

I'm a 44-year-old woman and I'm on the pill. Should I be?

I know you're not my gyno, and I will be seeing my gyno but not for six weeks. I'd like to get some info in advance so I'm sure to ask her all the appropriate questions.

I'm 44 and I've been on and off the pill at various stages since age 16. At first I used it purely for birth control, and in those early days it was expensive so I'd sometimes be on it for a while, then off for a couple of years, then on again when I could afford it, was in a relationship, etc.

After a long stage of not being on the pill in my late 20s, I started to have problems with my period. It would come very often (around every 20 days) and be very heavy and long. My gyno suggested going back on the pill specifically to regulate my periods. It worked, and I stayed on until I was in my mid-30s and wanted to get pregnant. I went off the pill, got pregnant easily, then breast-fed my child for a long time, so it wasn't until my kid was around 2-ish that my periods were back to a somewhat normal cycle, and again I started experiencing frequent, heavy periods. The gyno (by now a different gyno) suggested going back on the pill for the regulation aspect, so I did and it worked fine.

So here I am at age 44, still on the pill. Some basic facts:
-- I use Loestrin, or the generic approved by my insurance company, which seems to change every year or so.
-- I do not experience any unpleasant side effects from the pill.
-- I am very overweight. I do not smoke.
-- I do not wish to become pregnant, but I don't know if that would even be possible at this age.
-- I wonder what sort of stage I am in with regards to menopause. I do not know my mother's menopause history and will not be able to find out. Don't have older sisters. (Not sure if a sister/mother's experience with menopause is relevant.)

So I'm wondering if there's some sort of general rule when it comes to females around this age, about whether or not you should be on the pill as you age towards menopause?

I know there are risks associated with being on the pill. Do those increase as I age? Should that be a factor in my decision?

I had fairly low blood pressure my whole life until a couple of years ago. It has been creeping up, and is something my general practitioner is aware of and is keeping an eye on. I am hoping to deal with it through weight loss. Should this be considered with regards to being on the pill?

And is there anything else I should be thinking about when I have this discussion with my gyno?

(Anon because I don't want gynocological questions linked with my online presence.)

posted by anonymous to health & fitness (5 answers total)

I'm in a similar situation: 47, overweight, highish BP, taking Loestrin generic for Polycystic Ovary Syndrome. I think we're probably both fine since I believe Loestrin is the lowest dose pill you can get (or one of the lowest). I expect to go off it in a few years when I hit menopause, but will see what my doc says.

BTW, my blood pressure, after being high since I was in my 20s, is now near normal due to a combination of Lisinopril and exercise. No weight loss was needed. YMMV, of course.
posted by WorkingMyWayHome at 4:48 PM on January 6, 2012

I'm 35, on the pill for almost 15 years straight, and just recently had this talk with my gyn. It is OK to stay on the pill up until menopause provided you don't have things that mess with the risks that come with being on the pill over 35. You don't smoke, so that's a huge plus in your favor when it comes to pill risks, as is your decent blood pressure (assuming "creeping up" means still low/normal and not high).

Your planned weight loss may help with your blood pressure, but if your BP is already high, you may need to come off the pill until it improves. High cholesterol and other heart disease risk factors will play a role in the decision as well if you have them. If those are OK right now, you may just need to get checked annually to make sure that remains the case.
posted by dayintoday at 4:48 PM on January 6, 2012 [1 favorite]

I just want to say that the rate of unintended pregnancy in your age group is the second highest (right after teenagers! hooray!), so it's definitely still possible. If you want to get off the pill, please make sure you're protected for a little while longer here. Especially if you're planning weight loss, dropping weight can lead to surprising fertility.
posted by circle_b at 5:08 PM on January 6, 2012 [6 favorites]

I'm 46, rather overweight but not obese, and on the same pill, and my doctor has expressed no concerns. But only your doctor can look at your unique situation and advise you appropriately.
posted by matildaben at 5:40 PM on January 6, 2012

There is no age at which you cannot get pregnant, if you are still having menstrual cycles. So if you don't want to get pregnant, and you haven't gone through menopause, you should be using some form of birth control, doesn't have to be the pill.

If you go off the pill, you may find that your cycles are much more irregular. If that's something that will really bother you, then that is a consideration.

As far as health risks of staying on the pill, they include possible increased risk of breast cancer, questionable minimal increased risk of heart attack, and an increased risk of blood clotting such as blood clots in your leg or in your lungs. Stroke is considered a quite rare possible side effect of oral contraceptives (stroke is also caused by blood clots), and the risk is higher if you have high blood pressure. All these risks would be considered either small or minimal, but I would recommend reading the articles so that you are well informed. They are written for medical professionals but I think they would still be helpful.

On the positive side, oral contraceptives have a protective effect against ovarian cancer.

(I'm worried my links may not work because Medscape is a subscription only service. If they don't, you can get around the barrier by Googling "risks of oral contraceptive pills medscape" and "oral contraceptives offer long-term protection against ovarian cancer medscape")
posted by treehorn+bunny at 10:19 PM on January 6, 2012 [3 favorites]