Some of us going through early menopause or premature
ovarian failure are put on birth control pills; others on hormone replacement therapy.
Both act as hormone replacement; in other words, in both cases, you’re taking them to
replace the hormones your body used to make. But there are significant differences between
the two.
So, inevitably, questions come up: What are the differences? Is one better than
the other? Why am on one and not the other? As you’d expect, there are really no
simple answers! (Isn’t that always the case....)
That said, though, here’s an attempt at explaining this issue, the pros and cons
of each...and the reasons your doctor may have prescribed one of these for you.
BIRTH CONTROL PILLS
Let’s start with a look at Birth Control Pills: First, and most
importantly, it’s important to realize that birth control pills aren’t
for contraception only! Yes, you might have used them in the past to prevent pregnancy,
but if you’re prescribed them due to early menopause, POF, or perimenopause,
you’re not taking them for the contraceptive reasons as much as you are taking them
to boost your hormone levels.
When They’re Usually Prescribed....and Why
Most often, your doctor will suggest birth control pills for you if you’re perimenopausal
-- that is, you’re still getting your periods, you’re not testing at
post-menopausal levels, and you haven’t been diagnosed with POF or early menopause.
In this case, it’s likely that your doctor has suggested bcps as a way of helping you
cope with symptoms. This is becoming a fairly common treatment, because, although
you’re getting menopausal symptoms (like hot flashes, night sweats, and so forth),
you’re still producing a fair level of hormones on your own. And, unlike typical HRT
which supplements hormones in your body, birth control pills literally take over.
They override your own hormonal production -- in effect, signaling your ovaries to take
a breather and stop producing estrogen and progesterone -- and supplant it with the
hormones in the pills themselves. In other words, you get just what is in the bcp.
You’re not adding hormones on top of what you’re producing on your own, but
literally replacing them.
This is a key reason bcps are often prescribed if you’re perimenopausal and going
crazy with symptoms: In perimenopause, you’re still producing non-menopausal (that
is, higher) levels of estrogen and progesterone on your own, so adding more hormones (as
you would if you went on standard HRT) might actually make you feel worse. Your hormone
levels are usually fluctuating a great deal in perimenopause, so there could be days when
HRT would provide you with too much....and wind up causing symptoms from excess estrogen
or progesterone. In addition, since irregular bleeding is often one of the mostly widely
experienced symptom of perimenopause, bcps will regulate your bleeding.
All in all, you’ll get a set, steady amount of hormones that won’t fluctuate
according to your own ovarian production.
If you’ve been diagnosed with early menopause (EM) or premature
ovarian failure POF), though, it’s a somewhat different story. In this case,
the issue isn’t simply helping with symptoms, but also making sure your hormonal
levels are high enough to prevent consequences like osteoporosis. Many doctors feel that
younger women with low estrogen levels need higher dosages of estrogen than that in
standard HRT -- and the estrogen in birth control pills is more potent than that in
regular HRT. This is one of the key reasons doctors may suggest going on birth control
pills for women with EM or POF.
The estrogen in birth control pills is a synthetic form called ethinyl estradiol.
It’s a potent form of estrogen that is roughly four to ten times stronger than that
used in different types of HRT. Because it’s so much stronger, a number of doctors
feel it’s a wise choice for younger women going through POF or EM, as young
women’s hormonal needs are often far higher than those of older women in menopause.
Pros: If you’re perimenopausal, the big plus with bcps is, as
stated before, the fact that you’re not adding hormones on top of what you’re
producing on your own -- so you wind up with a very steady level of estrogen and
progesterone, helping you stop the hormonal roller coaster -- and the irregular bleeding
-- that’s so very common in perimeno.
If you have POF or EM: here too the notion of having your hormones set at a
stable level can be a big plus. In addition, the strength of the pill as compared to HRT
might be needed, since often younger women find that they don’t necessarily do as
well on standard dosages of HRT.
There are other benefits from the pill as well that apply to both situations: Studies
have shown that it helps prevent osteoporosis (a definite plus for young women going
through POF or EM, since bone loss due to low estrogen levels tends to be rapid and can be
severe, and reduces your risk of ovarian and endometrial cancer, as well as benign breast
disease (fibrocystic breasts). Some studies also have suggested that bcps may help protect
you against colorectal cancer, uterine fibroids and rheumatoid arthritis, but, in these
cases, the jury is still out.
Cons: The synthetic estrogen in birth control pills also has its
drawbacks. It is less easily metabolized -- which makes your liver work harder. There have
been studies linking use of birth control pills with an increase in strokes and blood
clots -- one reason why doctors will tell you not to go on the pill if you’re
over age 35 and smoke, have untreated hypertension, or a history of stroke, and other
blood clot related disorders (such as thrombosis or pulmonary embolisms). Bcps also may
cause breast tenderness or nausea.
In addition, there seems to be some debate where pregnancy is concerned. Some doctors
hold that the pill won’t act as a contraceptive for women with POF; others
feel that, if you’re hoping for a pregnancy, the pill isn’t your best choice.
Finally, while there are a number of different bcps available, there isn’t the wide
range of options that there is in HRT. Birth control pills always consist of synthetic
estrogen and progestin; there’s no patch form; and while you can get different doses,
there aren’t as many as with HRT.
HORMONE REPLACEMENT THERAPY
Now for a quick look at Hormone Replacement Therapy (HRT). This is the standard
type of hormone replacement given to women who have low hormone levels. Unlike bcps, HRT
doesn’t suppress the production of our own hormones, but adds hormones to our
bodies. Even after menopause your ovaries produce hormone -- although at much lower levels
than in the past. But since the levels are so low and don’t fluctuate the degree that
they might in perimenopause, adding hormones via HRT typically doesn’t cause the same
problems they might if you’re still producing pre-menopausal levels of hormones.
When They’re Prescribed and Why
Usually, hormone replacement therapy is prescribed once you’ve tested at
post-menopausal levels (that is, your FSH is high and your estradiol -- the primary human
estrogen -- low. For specific hormone levels, see Hormone Testing). Because women going
through POF or EM still get their periods sometimes -- even though their hormone tests
come in as post-menopausal -- the typical menopause rule of thumb of "wait until your
periods are done for one year before HRT" doesn’t really apply. In the case of
us younger women, the numbers tend to be the crucial factor.....and the impetus for a
doctor to suggest HRT.
The theory behind this is simple: Low estrogen levels -- particularly in a young woman
who is exposed to low estrogen long before the "normal" age -- can lead to
serious consequences, such as osteoporosis and cardiovascular problems. So replacing the
hormones helps prevent these problems and, at the same time, can help us cope with
symptoms ranging from hot flashes to mood swings to vaginal dryness. In addition, on the
quality of life side of things, often replacing hormones can make us feel better
again.....like our own ages.
There has been -- and probably will continue to be -- a great deal of debate about the
use of HRT; its risks and benefits, and so forth. But on the whole, there seems to be
little debate about its use for younger women, that is, women with POF or EM who are not
producing the usual levels of hormones for their age.
But what about perimenopause? What if you haven’t been diagnosed
with either POF or EM, but have been getting symptoms.....and are either considering HRT
or have had your doctor suggest it? Well, in some cases, doctors do prescribe
regular HRT for women going through perimenopause. It’s still not as common as being
prescribed bcps, but it appears to be done more often than in the past, perhaps because of
the introduction of more very low-dose estrogens. Usually, if you’re perimenopausal,
HRT is prescribed to help you deal with symptoms, since the risk of osteoporosis
Pros: Flexibility -- there are a wide range of options open to you where
HRT is concerned, not only different dosages, but also different forms -- i.e. patches vs.
pills.
Cons: If you’re perimenopausal: Because regular HRT
doesn’t suppress your own hormone production, you might experience heavier bleeding
and other side effects....due to excess hormones. Doctors sometimes suggest that
perimenopausal women on HRT get regular ultrasounds and/or uterine biopsies to keep track
of the uterine lining.
