Does birth control delay menopause?

Many women in their 40s and 50s have had a long relationship with some form of birth control — it’s like a reliable old friend you’ve trusted since your teens or twenties, quietly working in the background to prevent pregnancy. But during perimenopause, which is the years leading up to menopause, hormonal birth control can add a tricky element.

Hormonal birth control usually means forms of estrogen combined with progestin or solo progestin, and can come in many forms, such as oral contraceptive pills, the contraceptive patch, vaginal ring, injections like Depo-Provera, and intrauterine devices (IUD).

Often the first symptom women notice that alerts them to being in perimenopause is irregular periods. But since the hormones in birth control can artificially keep your periods regular or make you skip them altogether, you can’t really use your cycle as an indicator. So, does birth control delay menopause? Simply mask it? Here’s what experts want you to know.

What does perimenopause usually look like?

If you aren’t on hormonal birth control, perimenopause typically begins when periods go wonky sometime in your 40s. “Once you skip a period or reach a variation in your period lengths that’s greater than seven days, you’ve officially entered perimenopause,” says Dr. Stephanie Faubion, M.D., the director for the Center for Women's Health at the Mayo Clinic, medical director for The Menopause Society, and member of the WeightWatchers Scientific Advisory Board.

In a typical menstrual cycle, the ovaries release estrogen and progesterone in a predictable rhythm. “That pattern is what triggers the monthly building and shedding of the endometrial lining,” says Dr. Patricia Bhoola, M.D., an OB/GYN at WeightWatchers Clinic. “Perimenopause brings hormonal fluctuations — less consistent estrogen, and much less progesterone — and that imbalance makes ovulation irregular and directly leads to unpredictable, skipped, or heavy periods.”

Erratic changes in those hormones also trigger other menopause symptoms like hot flashes, difficulty sleeping, memory problems, moodiness, decrease in libido, and more.

What does perimenopause look like on birth control?

Your period likely won’t change much. The hormones in birth control either keep it regular, like how a 28-day pill pack’s placebo week triggers a period to start, or stop your periods all together, like some IUDs. This means your cycle isn’t going to be able to give you much information about where you are in the menopause journey. “If you’re on hormonal birth control, you can’t use the marker of bleeding or not to tell if you are menopausal,” says Faubion.

For most women, this isn’t a problem, says Bhoola, since there’s no important medical reason to know that you’ve entered perimenopause. Your body will continue to go through the process whether you’re aware of it or not. Unless you’re having symptoms, there’s no need to treat it.

Does birth control impact menopause symptoms?

Hormones in birth control may help offset some of the hormonal dips and spikes going on in your body, meaning they may also smooth over or even mask some of the symptoms of perimenopause, like hot flashes or irregular bleeding.

That said, the underlying menopausal transition is still happening in the ovaries. “Some women barely notice perimenopause changes while on birth control, while others may still have breakthrough bleeding, mood shifts, or other perimenopausal symptoms. The experience is very individual — just as it is for women not using birth control,” says Bhoola.

Whether you experience symptoms or not will depend on your body, as well as the hormones in your birth control of choice. For example, birth control options combining estrogen and progestin (such as most pills and the Nuvaring, Annovera, and EluRyng rings) deliver several times the dose of estrogen that’s in hormone replacement therapy (HRT), also called menopausal hormone therapy (MHT). So, it may be enough to subdue any symptoms, including hot flashes. One exception is the placebo week of estrogen-progestin oral pill packs, says Faubion. Since you’re not getting any hormones for those days, you may experience symptoms then.

Progestin-only birth control, on the other hand, such as the “mini pill,” implants like Nexplanon, and levonorgestrel IUDs (such as Mirena, Kyleena, Skyla, and Liletta) doesn’t contain any estrogen. Because estrogen fluctuations are to blame for the majority of menopause symptoms, you are more likely to experience them.

Will birth control hormones delay perimenopause?

Even though you won’t have that first clear sign of entering perimenopause — the irregular periods — being on hormonal birth control doesn't delay menopause, says Faubion. That’s true even if your birth control contains estrogen. Your body is still going to start decreasing the amount of estrogen and progesterone it makes — and do so in an erratic, up-down way.

Should you go off birth control during perimenopause?

While you of course can, you might not want to. “The 40s are the second-most common time of unwanted pregnancy beyond the teens,” says Faubion. And HRT doesn’t prevent pregnancy. “Contraception is absolutely needed until a woman is fully menopausal. That means 12 months without a period, and you can't tell if you’ve gone 12 months without a period when you’re on hormonal contraception.” That’s why your doctor may recommend you stay on hormonal contraception until the age of 55 if you’re healthy and don’t have contraindications, says Faubion. (That’s the age when most people have gone through menopause, so pregnancy is no longer a concern.)

Once you’ve entered post-menopause, however, your doctor will likely recommend you go off birth control. That’s because you don’t need to worry about pregnancy anymore and birth control that contains estrogen raises your risk for issues like blood clots, heart attack, and stroke. “Birth control delivers four to five times the dose of estrogen that’s in menopausal hormone therapy, so it’s way more than a woman needs to manage menopause symptoms,” says Faubion.

If you want to prevent pregnancy but not use hormonal birth control, non-hormonal options include condoms, a diaphragm, spermicides, the copper intrauterine device (IUD), and permanent options like a vasectomy for men or tubal sterilization for women.

Can you use birth control and HRT?

It depends on what type of birth control you’re using, but yes, your doctor may recommend that you combine certain birth control with HRT — and in some circumstances, “it can be smart to do so,” says Faubion. That’s because this combo can help you accomplish multiple goals at once, such as calming hot flashes and preventing pregnancy, that neither can do on its own.

One prime example is if you’re using progestin-only birth control, like a levonorgestrel IUD. In that case, your doctor may keep you on your birth control and prescribe estrogen-only HRT. (If you aren’t on birth control, you’ll need to take a combination of estrogen and progesterone replacement HRT to keep your uterine lining from getting too thick while managing your symptoms.)