At What Age Should Switch from Oral Contraceptives to Hormone Replacement Therapy?

In the past, it was thought that oral contraceptives could only be safely taken for a 10-year period and not past age 40. Studies now show that oral contraceptives can safely be taken until menopause with no limitations. As long as you do not smoke or have hypertension, you can take oral contraceptives for the duration of your childbearing years.

When you start to go through menopause, your body produces less estrogen, which can cause unpleasant symptoms such as hot flashes and vaginal discomfort. Hormone replacement therapy is one treatment option for women going through menopause.

Menopause is a natural event for women.

In the lead-up to menopause, your ovaries may not produce an egg each month. This can lead to changes in the hormones circulating in your body. Specifically, oestrogen levels may be increased and progesterone levels may be lower. After menopause, oestrogen levels also fall considerably. Women are considered ‘postmenopausal’ one year after their final menstrual period. Menopause usually occurs naturally at around age 50 but may happen earlier due to chemotherapy, radiation treatment, or surgery.

What is menopause?

Menopause consists of three stages:

• Perimenopause:  These are the years leading up to the final menstrual period and the year after the final menstrual period. During this time, changes in your hormones may lead to symptoms such as hot flushes and changes in menstrual bleeding patterns. Night sweats (hot flushes occurring at night) can cause sleep disturbances and affect your mood and concentration during the day. NB. Some women are still able to conceive during the menopause transition, so you should continue to use contraception until at least twelve months after your final period if you don’t wish to become pregnant.
• Menopause: is the spontaneous, permanent end to menstrual periods that is not caused by medical treatment or surgery. It is confirmed by twelve consecutive months of no menstrual bleeding.
• Postmenopause is the time beyond one year after your final menstrual bleeding and lasts for the rest of your life.

When does menopause begin?

Menopausal symptoms (hot flushes, night sweats, and menstrual changes) usually start around age 47. The final menstrual period is usually about age 51 but can vary considerably. There is currently no reliable way to predict when you will experience menopause or what your menopausal symptoms will be like.

When menopause happens before 40 years, it is called ‘premature’, and when it happens before 45 years, it is called ‘early’. Menopause after age 45 is considered normal, and there is no upper age limit for when it can begin. However, most women have experienced menopause by age 55.

Hormone Replacement Therapy for Women

Hormone replacement therapy is a medication containing estrogen, which replaces the estrogen your body is no longer producing during menopause. There are two primary types of hormone replacement therapy: systemic hormone therapy and low-dose vaginal products.

Systemic hormone therapy can come in the form of a pill, skin patch, ring, gel, cream, or spray. It contains a higher dose of estrogen that is absorbed throughout the body. Low-dose vaginal products, on the other hand, can come in the form of a cream, tablet, or ring. These products offer a lower amount of estrogen, typically used to treat only vaginal or urinary symptoms of menopause.

These hormone replacement therapies are often prescribed along with progesterone to help balance out the estrogen and reduce the risk of endometrial cancer. However, it’s important to understand that there are some risks associated with hormone replacement therapy, including an increased risk of heart disease, stroke, blood clots, and breast cancer. Your risk level depends on your age, type of therapy, and health history. So, it’s important to consult your doctor before starting any hormone replacement therapy.

Benefits of Hormone Replacement Therapy During Menopause

Hormone replacement therapy treats symptoms of menopause such as hot flashes and vaginal discomfort, which can help women achieve a higher quality of life during this time. Hormone replacement therapy can also prevent bone loss and reduce bone fractures in postmenopausal women.

While there are several benefits, hormone replacement therapy is not right for everyone. If you have a history of vaginal bleeding, cancer, stroke, heart attack, blood clots, or liver disease, you may not be a candidate for hormone replacement therapy.

When to Start Hormone Replacement Therapy

The average age of menopause in the United States is 51. The telltale signs of menopause include irregular periods, vaginal dryness, hot flashes, chills, night sweats, sleep problems, low sex drive, mood changes, and weight gain. At that time, many women switch from oral contraceptive pills to hormone replacement therapy.

However, some women have found that using oral contraceptives during the first few years of menopause (perimenopause) may be helpful in controlling any abnormal bleeding that may be present. Once you have gone through menopause and are no longer experiencing abnormal bleeding, you may not need the higher doses of estrogen found in oral contraceptive pills. By taking the lower doses of estrogen found in hormone replacement therapy, you will decrease the risks associated with estrogen, such as breast cancer and developing blood clots.

It’s important to talk to your health care team about the benefits and risks of hormone replacement therapy during or after menopause.