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.
Dr. Marianne Legato, Professor Emerita of Clinical Medicine at Columbia University is an internationally known academic physician, author, lecturer, and specialist in gender-specific medicine. She is founding member of the International Society for Gender Medicine and also the founder and director of The Partnership for Gender-Specific Medicine at Columbia University and its next iteration, The Foundation for Gender-Specific Medicine. These enterprises are the first collaborations between academic medicine and the private sector focused solely on gender-specific medicine: the science of how normal human biology differs between men and women and of how the diagnosis and treatment of disease differs as a function of gender and sex. Her ground breaking textbook on Gender-and Sex Specific Medicine has been published in 2017 in the 3rd edition.
She has published extensively on Gender and Sex Specific Medicine, both scientifically and for the lay public. She is also the founding editor of the journal Gender Medicine, and the Journal Gender and Genome, published for the scientific community. In 1992, Dr. Legato won the American Heart Association’s Blakeslee Award for the best book written for the lay public on cardiovascular disease. She is a practicing internist in New York City and has been listed each year in New York Magazine’s “Best Doctors” since the feature’s inception in 1993.