Women going through the transitional
phase of perimenopause may need help dealing with
the body's reaction to the slightly decreased
levels of the ovarian hormone estrogen. Oral contraceptives
are increasingly being considered to fulfill this
role.  Even though the use of oral contraceptives
in this way has not been approved by the FDA,
it has been scientifically proven that these contraceptives
also offer several additional health benefits
beyond birth control for the perimenopausal woman.
However, just as when used in earlier years of
a woman's life and Women's Health Issues, oral
contraception does carry some risks. Be sure to
consult a doctor when considering this option
for treatment of any perimenopausal symptoms.
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Starting Oral Contraceptives
for Perimenopause
Unlike regular hormone replacement therapy, there
are not well-defined criteria for when a woman can
start using oral contraceptives to treat perimenopausal
symptoms. If a woman suspects that she has symptoms
due to perimenopause that bother her enough to need
medication, she can really start whenever she wants.
All she needs to do is see her doctor to make sure
none of the contraindications apply to her.
Oral Contraceptives for Perimenopausal Women
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Many women experience irregular periods, intensified PMS, and irritability before they meet the clinical requirements for starting hormone replacement therapy. For these women, the newest treatment is birth control pills. These pills can alleviate annoying symptoms while offering protection from unwanted pregnancy. |
Benefits of Oral Contraceptives
for Perimenopause
In addition to protecting Women's Health against
unwanted pregnancy, oral contraceptives are also very
effective at relieving the annoying symptoms that
may be brought about by perimenopause. Some of these
symptoms that can be relieved are:
Pre-menstrual syndrome: PMS can sometimes
get worse with the onset of perimenopause.
Menstrual cycle irregularity: perimenopausal
women will often start to experience an erratic
menstrual cycle.
Growing menopausal symptoms: oral contraceptives
may relieve minor hot flashes, irritability, insomnia,
and any other symptoms common to the beginnings
of menopause.
Side-Benefits of Oral Contraceptives
While the main goal of using birth control pills
for perimenopausal women is to get rid of certain
perimenopausal symptoms, women using these pills can
also get some other important health benefits. Some
of them are:
A small decrease in bone loss: estrogen prevents
the reabsorption of bone while stimulating the release
of calcitonin, which maintains bone mass. Therefore,
a decline in estrogen levels due to perimenopause
results in bone loss, which can lead to osteoporosis
and fractures. Supplementing a woman's body with small
extra doses of estrogen can thus slow this harmful
process. The best dose to use is 25-35 micrograms
of ethinyl estradiol combined with the progestin norethindrone
(click here for a list of birth control pills that
fit this criteria).
Management of fibroids: some perimenopausal
women will develop leiomyomas (tumors made up of smooth
muscle tissue) in their uterus. Oral contraceptives
may be useful for treatment of these tumors (also
called fibroids).
If oral contraceptives are used for long periods
of time, they can also play a role in the prevention
of endometrial and ovarian cancer. Increasing the
amount of time that these pills are taken results
in more protection. However, the minimal number of
years required to see these positive effects for endometrial
cancer is 2 years and for ovarian cancer it is 3.
Therefore, if a perimenopausal woman is simply using
oral contraceptives for a year to get rid of some
of her pesky symptoms, she will not get these benefits.
Some good news though is that, as long as she is healthy
and does not smoke, oral contraceptive use in perimenopausal
women does not increase the risk of having a stroke.
Lipid levels are also not negatively affected.
The effect of hormonal supplements on the risk of
breast cancer is a topic that has long been debated.
It has been shown that oral contraceptives may have
a protective effect against the development of breast
cancer only for the breast tissue that has no sign
of malignancy already. The caveat here is that, if
some breast cells have already become malignant, the
use of oral contraceptives can actually speed up the
development of breast cancer in these cells. But,
there is no evidence that it causes those malignancies
in the first place.
Special Considerations
for Migraine Sufferers
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Unlike the average
woman, women who experience migraine headaches
should think twice about using oral contraceptives
during perimenopause. It has been suggested that
a history of migraines can increase a woman's
risk of having a stroke.
However, this seems to
be limited to women who have an aura before their
migraines or who have other neurological symptoms.
For this reason, if a woman is considering starting
birth control pills for the alleviation of perimenopausal
symptoms and is also experiencing migraines, she
should be sure to see a neurologist first. He/she
will be able to tell whether or not it would be
okay to start on the pills. |
For women who have migraine headaches
that are not associated with neurologic symptoms,
a low-dose oral contraceptive can probably be used,
but consulting a doctor would be a good idea. Use
of the pills should be ended if the headaches get
any worse or if they start occurring more frequently.
Who is Not Eligible
The contraindications listed for use
of oral contraceptives in women past age 35 are:
- Smoking
- Hypertension
- History of thromboembolism (a condition that involves
blood vessel clots)
Stroke
- Estrogen-dependant abnormal tissue growth (tumor
or cancer)
- Undiagnosed atypical genital bleeding (vaginal bleeding)
- Cholestatic jaundice (jaundice that is caused by
blockage of the outlet of the gallbladder)
Transition to Hormone
Replacement Therapy
At some point after oral contraceptives have been
used to alleviate the symptoms of perimenopause, the
woman will need to transition to regular HRT. It has
been suggested that FSH (follicle stimulating hormone)
levels during time off from the pills (during use
of a placebo) can be used, but this method may be
unreliable. This is because the pill suppresses the
woman's own hormone levels so that they may not return
to their natural levels in this short time. A combination
of FSH and estradiol levels should be used instead
for greater accuracy. An easier way to transition
is simply to pick a time somewhere between the ages
of 50-52 to switch from oral contraceptives to hormone
replacement therapy. Since a woman is already taking
a form of hormone replacement, the start of regular
HRT is not as critical.
Here are some HRT programs to consider when transitioning:
Continuous combined therapy: involves a combination
of estrogen and progesterone administered on a daily
basis. The optimal dosage would be the equivalent
of 0.625 mg of conjugated estrogen and 2.5-10 mg of
medroxyprogesterone.
Pros: may stop menstruation
Cons: breakthrough bleeding (particularly during the
first year); may not be as effective for preventing
endometrial cancer.
Cyclic therapy: estrogen given on a daily basis with
progesterone added in for the first 12-14 days of
each month. The estrogen dose should be the equivalent
of 0.625 mg of conjugated estrogen and the progesterone
dose should be 5-10 mg of medroxyprogesterone.
Pros: less breakthrough bleeding
Cons: still have menstruation (occurs monthly when
progesterone is stopped)
Cyclic therapy: estrogen given for the first 25 days
of each month and progesterone added on days 13-25.
Again, use a dose of estrogen that is equivalent to
0.625 mg of conjugated estrogens and 5-10 mg medroxyprogesterone.
Pros: less breakthrough bleeding
Cons: still have menstruation (when progesterone is
stopped)
Estrogen combined with progesterone for the first
25 days of each month.
Pros: may be more effective in protecting endometrium
Cons: still have menstruation (occurs monthly when
hormone doses stop)
Oral Contraceptives
to Use
Here is a list of the oral contraceptives that are
the best for use during perimenopause to slow bone
loss. All of them contain 25-35 micrograms of ethinyl
estradiol plus norethindrone.
Mono-phasic:
Norinyl 1+35
Ortho-Novum 1/35
Brevicon
Modicon
Ovcon 35
Bi-phasic:
Ortho-Novum 10/11
Tri-phasic:
Tri-Norinyl
Ortho-Novum 7/7/7
Jenest 28 |
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Cholesterol
Levels in Women
Your doctor wants to start you on medicine because
of your levels. Surprisingly, it can mean different
things for women that it does for men. The standard
advice might not be right for you.
What are
HDL and LDL?
HDL and LDL are two different kinds of cholesterol
that are measured as an index of a patient's
risk for cardiovascular disease. HDL stands
for high-density lipoprotein and LDL stands
for low-density lipoprotein. Total cholesterol
measures the combination of HDL and LDL, along
with several other factors. The levels of
"fats" in the blood-total cholesterol,
HDL (a subset called "good cholesterol")
and LDL ("bad cholesterol") and
triglycerides have been used for years to
predict the risk of heart disease in men.
Higher cholesterol, LDL, triglycerides, and/or
low HDL all are associated with increased
risk of heart diseases in men.
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What do the numbers
mean?
Many studies found that women with higher total
cholesterol levels also had higher rates of a form
of heart disease called coronary artery disease. That
is where the arteries to the heart become clogged.
This leads to heart attacks. For cholesterol, levels
of about 200 or less are generally not associated
with much increased heart disease. Women with total
cholesterol levels of 265 or more have been found
to have this disease two or three times as often as
women with levels of about 200. Even mildly elevated
levels, of about 235, had about 70% higher rates,
than normal.
Men in the same situation are put on a diet and drugs
to lower their cholesterol. The goal was to increase
HDL, and lower LDL and total cholesterol. Little was
done to lower elevated triglyceride levels. The men's
rates of disease dropped. A closer look at the problem
in women found something different. Low HDL ("good
cholesterol") levels were the strongest predictor
of heart disease in women. These are generally levels
less than 50 (mg/dL). Low HDL and high cholesterol
go hand in hand for many, which led to the confusion
about what was important. Women with total cholesterol
levels as low as 200 who also had low HDL levels still
had high risks of heart disease. In fact, the best
predictor for women, according to one study, was the
ratio of cholesterol to HDL. If a woman's total cholesterol
is about 4 times or so of her HDL level, her risk
of heart disease skyrockets to up to five times that
of her normal counterpart. If her triglycerides are
high, her risk goes up, too. Again, that happens even
if she has a low total cholesterol level.
Unlike men, a high LDL ("bad cholesterol")
level is not as strong a predictor of future trouble,
although there is still considerable debate on this.
Some experts believe LDL is not to be worried about
for most women, except for particular sub-groups of
women who are affected. As one might expect, until
we clarify the importance of LDL for women and factor
in the additional significance HDL has for women,
the HDL/LDL ratio's significance is muddied.
The Bottom Line
Total cholesterol in and of itself does not matter
so much. Look at the other factors and ratios: especially
HDL, triglycerides, and the cholesterol to HDL ratio.
The significance of LDL and ratios with it are uncertain.
Most of all, keep checking for new research. This
area is rapidly changing for women.
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