Q. My doctor took me off the Pill seven years ago, when I turned forty, because he said it was not safe for a woman my age to take it any longer. I have a close friend who is my age who is still taking the Pill. Recently, my periods have become very heavy and irregular (my body used to work like clockwork), and I have begun to experience some of the symptoms of menopause such as vaginal dryness and fatigue, but my friend on the Pill is experiencing none of these changes. In fact, she said that she is as regular as ever and has never felt better. Could the reason that she is doing so much better than me be that she is still on the Pill?
A. At one time, doctors used to routinely take women off the Pill at around age thirty-five because the long-term effects of oral contraceptives were still unknown. Several recent studies have confirmed that the Pill – especially the new low-dose ones, are safe for non-smoking women throughout their forties. In fact, the FDA has approved the use of the Pill for a woman up to the age of fifty. Today, as many as 1.5 million women past the age of forty are on the Pill.
There are several benefits to taking the Pill right up until menstruation ends. The Pill is an excellent contraceptive, and even though a woman is nearing menopause, it does not mean that she is not capable of getting pregnant. The Reduction in menstrual cycles may give a false sense of security, but unless a couple is using contraception, there is always a risk of pregnancy.
The Pill can also leave much of the discomfort associated with the transition from the end of menstruation to menopause. As women approach menopause, they typically go through periods known as perimenopause in which they often have erratic periods characterized by either very heavy bleeding or breakthrough bleeding.
Breakthrough bleeding is more than just an annoyance, it is a sign of a more serious problem and must be investigated – a process that can often lead to medical tests that are both anxiety-provoking and uncomfortable. Women on the Pill, however, are getting a steady dose of estrogen, which will keep their periods regular and spare them many of the other unpleasant symptoms of perimenopause and menopause.
In many cases, Women on the Pill will not even know when they become menopausal. Therefore, it may be necessary for these women to take a blood test, in which their hormone levels will be altered accordingly, to determine if they have reached menopause. (The Pill contains higher levels of estrogen and progesterone than hormone replacement therapy).
If you’re interested in going back on the Pill, talk to your doctor about whether you are a good candidate.
Marianne J. Legato, MD, Ph. D. (hon. c.), FACP is an internationally renowned academic, physician, author, lecturer, and pioneer in the field of gender-specific medicine. She is a Professor Emerita of Clinical Medicine at Columbia University College of Physicians & Surgeons and an Adjunct Professor of Medicine at Johns Hopkins Medical School. Dr. Legato is also the Director of the Foundation for Gender-Specific Medicine, which she founded in 2006 as a continuation of her work with The Partnership for Gender-Specific Medicine at Columbia University. She received an honorary PhD from the University of Panama in 2015 for her work on the differences between men and women.
At its core, gender-specific medicine is the science of how normal human biology differs between men and women and how the diagnosis and treatment of disease differs as a function of gender. Dr. Legato’s discoveries and those of her colleagues have led to a personalization of medicine that assists doctors worldwide in understanding the difference in normal function of men and women and in their sex-specific experiences of the same diseases.
She began her work in gender-specific medicine by authoring the first book on women and heart disease, The Female Heart: The Truth About Women and Coronary Artery Disease, which won the Blakeslee Award of the American Heart Association in 1992. Because of this research, the cardiovascular community began to include women in clinical trials affirming the fact that the risk factors, symptoms, and treatment of the same disease can be significantly different between the sexes. Convinced that the sex-specific differences in coronary artery disease were not unique, Dr. Legato began a wide-ranging survey of all medical specialties and in 2004, published the first textbook on gender-specific medicine, The Principles of Gender-Specific Medicine. The second edition appeared in 2010 and the third edition, dedicated to explaining how gender impacts biomedical investigation in the genomic era, won the PROSE Award in Clinical Medicine from the Association of American Publishers in 2018. A fourth edition is forthcoming.
She also founded the first scientific journals publishing new studies in the field, The Journal of Gender-Specific Medicine, and a newer version, Gender Medicine, both listed in the Index Medicus of the National Library of Medicine. She has founded a third peer-reviewed, open access journal, Gender and the Genome, which focuses on the impact of biological sex on technology and its effects on human life.
Dr. Legato is the author of multiple works, including: What Women Need to Know (Simon & Schuster, 1997), Eve’s Rib (Harmony Books, 2002), Why Men Never Remember and Women Never Forget (Rodale, 2005), Why Men Die First (Palgrave, 2008), The International Society for Gender Medicine: History and Highlights (Academic Press, 2017), and most recently, The Plasticity of Sex (Academic Press, 2020). Her books have been translated into 28 languages to date.
As an internationally respected authority on gender medicine, Dr. Legato has chaired symposia and made keynote addresses to world congresses in gender-specific medicine in Berlin, Israel, Italy, Japan, Panama, South Korea, Stockholm, and Vienna. In collaboration with the Menarini Foundation, she is co-chairing a symposium on epigenetics, Sex, Gender and Epigenetics: From Molecule to Bedside, to be held in Spring 2021 in Italy. She maintains one of the only gender-specific private practice in New York City, and she has earned recognition as one of the “Top Doctors in New York.”