Menopause Hormone Therapy vs. Birth Control Pill: Two Different Tools for Perimenopause
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Menopause hormone therapy (hormone replacement therapy) and oral contraceptives are NOT the same thing.
Both can be appropriate during perimenopause, but they serve different purposes. Which is the better option depends on your symptoms, your need for contraception, your medical history, and your personal goals. For some, neither is a good option, but it can be helpful to understand some of the differences.
See last week's article (link) for a more detailed breakdown of oral contraceptives and IUD!
Menopause hormone therapy = Hormone therapy = Hormone Replacement Therapy
A common regimen would be topical estradiol (in gel or patch form) and oral micronized progesterone in someone who has a uterus.
The intention of this therapy is to decrease symptoms associated with perimenopause and menopause resulting from the lack of production of estrogen and progesterone as ovary function declines.
It is NOT designed to suppress ovulation, so many people in perimenopause continue to ovulate and produce their own hormone (erratically because that’s what happens in perimenopause). As such you can still have cyclic related symptoms and you can still get pregnant!
It provides a low steady dose of these hormones to ensure they don’t dip too low. In perimenopause your natural estrogen/progesterone might be much higher than this at points in your cycle, but this helps to avoid the lowest levels. This can be very helpful for symptoms of low hormones such as hot flashes and night sweats, and vaginal tissue health. And for some people brain fog, joint pain, mood, sleep, blood sugar, sexual health/libido and overall quality of life when caused by low hormones.
Pros:
Helps to decrease symptoms resulting from low estrogen and low progesterone
Supportive in terms of bone density
Quite safe especially compared to oral estrogen as the estrogen is topical meaning it’s not metabolized by the liver. As such it has a more favorable risk profile than oral estrogen with respect to blood clots, cholesterol, and cardiovascular risk.
Cons:
Doesn’t treat heavy menstrual bleeding, menstrual pain, or premenstrual symptoms
Does not prevent pregnancy
Oral contraceptive
It is most classically a combination of synthetic oral estrogen + progestin, or progestin only
It gives a high enough dose of hormone to BLOCK ovulation - meaning that it overrides your natural hormone production.
Pros:
Prevents pregnancy
Can decrease symptoms such as PMS/PMDD, menstrual pain, acne, heavy menstrual bleeding, and symptoms of excess testosterone (dark chin hairs, acne) as it BLOCKS hormone production
Cons:
Has a higher risk profile compared to topical estrogen in terms of impact on cholesterol levels, blood clot risk, and cardiovascular risks.
Neither option is "better" overall. They simply have different goals. The right choice depends on your symptoms, need for contraception, age, medical history, and personal risk factors. Want to understand more? Book something here!
Disclaimer:
This content is for informational and educational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, naturopathic doctor, or other qualified healthcare provider with any questions you may have regarding a medical condition or health concern. Never disregard professional medical advice or delay seeking it because of something you have read here.
Hi, I’m Dr. Janine, ND
I’m a Naturopathic Doctor currently practicing in Guelph, Ontario, Canada.
I truly believe that our enjoyment of life is closely tied to how we feel physically. When we’re healthy, we can take on anything. But when we feel off, even the simplest tasks become overwhelming. I’ve been through hormonal shifts, sleepless nights as a parent, and the stress of balancing everything. But I also know that with the right strategy, we can go from surviving to thriving—and create a healthy, thriving family in the process.
I look forward to meeting you soon.
- Dr. Janine, ND
Follow me on social media, @dr.janine.nd