Birth control during menopause? (And general menopause anxiety)
December 18, 2017 3:15 AM   Subscribe

How does one deal with birth control during menopause? I keep seeing that yes, you can get pregnant and need to keep using birth control - but you can't use HBC because it will mask menopause. So, what, is it back to condoms?

I am coming up on 50 in a year or so. My partner is male and we have PIV sex. I have been on a combined hormonal birth control (levonorgestrel / ethinyl estradiol) that allows periods once/3 months for six or 7 years now. Because the HBC currently controls my cycle, my doctor says that the way to tell if I've reached menopause is to stop the birth control when I turn 50 and... wait and see what happens. Menopause is defined as a year with no periods, and obviously I don't want to get pregnant during that time. So what am I supposed to do about birth control? Go back to condoms? Are there IUDs that don't have hormones, or any other good options? Is it even ok to use an IUD during (potential) menopause?

Also, I am generally a little anxious about the effects of menopause (and afterwards). My mother was on HRT until they stopped it after that big study, and she said when she went off it, she felt like like she had PMS for a year. A friend once told me she felt fuzzy and like she couldn't think well after menopause. I am a little concerned about what will happen to my emotions (I tend towards depressed/anxious/teary/reactive) and intellect. And yet I see lots of accomplished, competent women who are in or past menopause, so it can't really make us all crazy or stupid. What it really like? What can I do to mitigate any negative effects? What would be helpful for me to know, or what might make me worry less about this? Personal anecdotes welcome, as well as resources such as web pages, blogs, podcasts, articles, or books.
posted by anonymous to Health & Fitness (11 answers total) 4 users marked this as a favorite
The simplest answer to the birth control issue is for your partner to get a vasectomy. As far as menopause goes everyone's experience is different, so there is no need to get anxious about it now. You may be just fine, many women are.
posted by mareli at 4:56 AM on December 18, 2017 [5 favorites]

They can perform a blood test to see where your follicle stimulation hormones and estrogen levels are at. If your FSH is high and your estrogen is low (on or off HBC) then that indicates that ova are not likely being released as part of menstruation.

There are IUDs that don’t have hormones.

Yes, there is a certain amount of “wait and see what happens” as the HBC exits your system. In my personal experience, I was on HBC for 20+ years and then switched to an estrogen patch and progesterone tablets, then to PremPro (a single estrogen/progesterone tablet similar in principle to HBC). I wasn’t having sex at the time so that part wasn’t a factor, but in my experience, HBC kind of forced my body to menstruate even though my estrogen levels were barely detectable even on the Pill, and the patch made me spot. I don’t bleed so much as a drop on PremPro, even when I went off it for a week to see if I would.

As far as your mental and emotional effects, those can be mitigated with proper sleep and exercise, making sure your iron, thyroid function, vitamin D, vitamin B12 levels are all okay, etc. Menopause can create some brain fog because of a drop in estrogen, and having those levels be out of whack can contribute. If you tolerate HBC well, you might consider HRT to take the edge off.

I have ADHD anyway, so being a little scattered is frustratingly normal for me, but I didn’t turn into a dumbass. My situation is a little unique in that I went through menopause as a teenager (premature ovarian failure) and have been mitigating it all this time, so I’ve been through several rounds of on/off when I could or couldn’t afford the medication. As you no doubt know as well as I do, HBC can exacerbate emotions too, so for all you know, you could feel less reactive and anxious than you normally do. I know that I was much more reactive on a triphasic Pill than on a monophasic one.

So...I guess my ultimate advice is to first get a blood test to see where your levels are at. Then get some back-up birth control for a few months (I know, it’s a drag) and see what happens, but know that if it sucks, you have options.

I might also suggest that, if your partner knows he doesn’t want any more children, maybe he should consider a vasectomy. You could also consider getting your tubes tied or something permanent. That would eliminate the pregnancy worry (which I totally get, even though I was infertile *and* on birth control, nobody wants to be Sarah to somebody’s Abraham).
posted by Autumnheart at 4:56 AM on December 18, 2017 [3 favorites]

If you and your partner are sure you no longer want children, then yes vasectomy sounds easiest. My husband had a no needle/no scalpel procedure. It took about 20 mins (plus a consult a week or so before.) He was sore for a few days. Note that it takes a couple months before you can do tests to confirm results so you'll need a backup such as continued birth control or condoms.

Vasectomy was the best choice we ever made and should have done it so much sooner (during mid 20s, never want kids) I had to stop BC due to side effects soon after.
posted by Crystalinne at 5:07 AM on December 18, 2017 [2 favorites]

Blood tests to check for menopause aren't reliable a d they are doubleplus unreliable when you've been on the pill.
posted by chiquitita at 5:12 AM on December 18, 2017

But a high FSH will be informative. My FSH was always high regardless whether I was on the Pill or not. If it’s in the normal range then it would be reasonable to conclude that one is still releasing eggs.

It’s true that at least a few months of “go off hormones and see what happens” is inevitable. That’s basically how you test what happens to your endocrine production.
posted by Autumnheart at 5:21 AM on December 18, 2017

I'm 51, went off bcp and didn't have a period for 6 months. I had crazy hot flashes, lost 20 pounds. My FSH one month off bcp was 70. Dr. assured me no bc was needed. When I had two normal periods 6 months later I had another FSH, it was at 15, high but within normal range. Dr. said without hesitation that I do not need to worry about bc even though I really quizzed him about it. I don't think he would risk saying this if it weren't true, but that is just my feeling about it knowing this Dr. I asked him if my husband or I should get our tubes tied and he said definitely not--side effects for both are not to be taken lightly and we just don't need to do that. He said at 51 pregnancy is just not going to happen--conditions just aren't all together even if FSH is low. I'm a scientist my husband is a veterinarian--we're highly skeptical people about most things. He's a highly rated Dr. from the Cleveland Clinic FWIW. Take this as one woman's story and it is not advice on what I think you should do, but I'm OK with it.
posted by waving at 5:52 AM on December 18, 2017

Non-hormonal IUD, here, and perimenopausal. I haven't worried about pregnancy in almost a decade and I can't recommend it highly enough! It's been the biggest libido enhancer ever. I'm in the US and my partner and I recently talked about him getting a vasectomy because of my concerns about IUDs being eliminated from my insurance coverage by the time I need to get it replaced (in about 2 years), and because I want to have the removal of the IUD as a "tool in my toolkit" if menopause symptoms make me reconsider the use of it.

Re: anxiety about menopause. So far I have chalked 99% of this up to cultural stigma and tried to set it aside, concentrating instead on dealing with what is actually true for me at any given moment. Hot flashes, emotional vulnerability, etc. all feel pretty 'normal' for such a big change and I've given myself permission to be curious, experiment with self care and expressing my moods directly so that when they're over, they're over. This, IMO, is good practice anyway. But I refuse to mask and apologize for having reached the age of menopause. If our younger women can run marathons with their periods, then by cuss it, I'm going to be a menopausal woman in the world.

While that is a bit of a pep talk, so far I've had only minimal changes in mood and intellect directly attributable to menopause, though my sleep is out-of-whack and my general mood and thought processes can reflect that gap. I make sure to exercise, have gotten more focused on healthy eating habits, with a goal of coming into my 50th year with a healthy weight, eating habits, and self care, and so far feel good. (It's early, tho!) My biggest concern, mood-wise, is having my oldest kid enter his teenage years with me entering menopause. Meditation is something I'm getting more diligent about for that, and also just keeping the lines of communication open with household members about our changing physical realities. I want my sons to enter their adult years educated about and respectful of the stages of a woman's body and life.

For general medical/health care, I have consciously opted for female primary physicians slightly younger or slightly older than I am. I just think they'll have their eyes on my entire system, be willing to entertain ancillary tests and ideas, and have their antenna tuned to studies that will likely affect them, too.

Try to befriend some of those accomplished, competent peri- and post-menopausal women you meet! I've appreciated a friend of mine who's 15 years older. Seeing her progress through menopause and life changes from the role of mother to empty-nester has been a model and inspiration.
posted by cocoagirl at 7:22 AM on December 18, 2017 [1 favorite]

Also, a diaphragm is very effective when used consistently and correctly. Might be a good solution -- it's main downside is having to anticipate when sexual activity might occur (need to insert within two hours beforehand), but maybe at this age you're less likely to be suprised about that anyway?
posted by acm at 8:50 AM on December 18, 2017 [1 favorite]

The main downside of diaphragms for people I know has been the constant UTIs they can produce.

My doctors all seemed concerned about the possibility of pregnancy even after age fifty.

My endocrinologist had me stay on continuous birth control pills, which suppressed my cycle altogether, until we were pretty sure I was completely done with menopause, based on my mother's age at menopause. That meant age fifty-five. This was partly because I have some bad uterine fibroids and did not want a hysterectomy, and partly because for some reason my hip always hurt dreadfully when I was menstruating. It worked beautifully. I sailed through menopause. None of the horrible heavy bleeding, clots, cramping, etc. that my friends all reported. Nothing at all. I get about one hot flash a day, but not bad enough to start sweating. The only problem is the new ten pounds that appeared without any increase in food consumption or decrease in exercise. Oh, that and the rosacea on my face got worse. My migraines are better but not yet gone, which is kind of a disappointment to me.

Interestingly, menopause was signaled for me (before quitting the pills) by getting a lot less hairy. This was kind of a bummer because I could always use the speed at which the hair grew on my legs as a quick gauge of my thyroid levels. On the other hand, it's nice not to want to shave my legs every other day.
posted by artistic verisimilitude at 10:59 AM on December 18, 2017

IANYOBGYN, so please speak with your doctor. But why not just stay on HBC if it's working for you until you pass an age when you are even less likely than now to be fertile when you stop? Has your Gyn said you need to stop OCPs for some reason?

FWIW, while I generally always recommend vasectomies over tubals for all my patients it does seem a little silly to get a surgical procedure for for the likely 1-4yrs of coverage you might need in this case, especially if you have a method that's working fine for you now.

While it's not impossible for someone your age to get pregnant, it is very very unlikely. To quote one of the more famous studies on natural fertility, "Although exceptions exist, there are few spontaneous conceptions that result in live births in women over 43 years of age." Perhaps reassuring, perhaps not, but if you were to get pregnant, your chance of having a miscarriage is around 95% in your age range.

And yes, if you'd like to switch there are both hormonal and non-hormonal IUDs. Given your anxiety about hormones masking menopause (defined--as upstream--by 12mo without a period) you might be comforted by using a paraguard without hormones and then removing it (or not) when you hit that mark.

Average age of menopause in the US is 51, but varies according to personal and family history.
posted by eglenner at 11:23 AM on December 18, 2017 [1 favorite]

My personal anecdote about the effects of menopause is that it's been fine. No notable emotional or intellectual changes. I'm happy most of the time. But before menopause I didn't tend to be depressed or anxious and never had any PMS-like symptoms.
posted by Redstart at 4:32 PM on December 18, 2017

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