What happens in Perimenopause if you’re on the Pill or have an IUD?

Perimenopause is a hot topic these days and comes up with most of my patients who are menstruating >38yo.  

Perimenopause is the transition between regular ovulatory cycles and the cessation of menstrual cycles altogether.  A transition which may happen over a 1 to 10 year window.

As egg quality/quantity is decreasing, we will have some cycles where you ovulate - and as such make progesterone (which only happens when you ovulate), and other cycles where you don’t.  There will be some moments in the month where estrogen sky-rockets and some moments when it tanks.  Typically the FIRST sign to say that you’re in perimenopause would be changes to menstrual cycles - cycles getting longer or shorter, or blood flow changing.  

But what happens on the pill? 

Most types of taditional oral contraceptives (estrogen + progestin) work by blocking ovulation, so we’re NOT seeing ovulation, progesterone production, or fluctuating estrogen levels, we’re seeing a steady state of estrogen and progestin.  While blood flow patterns may change, the changes don’t tell us a lot about whether you’re in perimenopause or not because the hormone status is steady state.  We have to rely on symptoms such as hot flashes, night sweats, and vaginal dryness to get more information about whether perimenopause is part of the picture or not. 

An IUD is even trickier to decipher as some people will ovulate with an IUD and others will not, some will experience bleeding and others will not, and bleeding patterns can inherently be erratic with an IUD so it’s difficult to know what’s what.

Does it matter? Maybe not. 

If you’re having difficulty sleeping we want to treat the difficulty sleeping, it doesn’t necessarily matter if you’re in perimenopause or not. 

If you’re having anxiety - we want to treat it, if you’re struggling with low energy  - we want to treat that. 

If you’re in your 40s we want to think about building muscle mass, managing blood sugar and cholesterol, and managing stress whether you’re in perimenopause or not. 

Whether you’re in perimenopause or not, we want you to feel your best and will do things to be proactive in your plan!

So, why should you care?

We can’t stop the process of perimenopause. 

We don’t need to regulate your bleeds on the pill or IUD.

But we CAN make the experience much smoother.

We CAN make sure you have the foundations to feel your best self and manage your symptoms. 

We can make sure you know your options in terms of treatment.

If you’re looking for support during your transition into perimenopause, reach out and book a visit today!