What is Menopause?Menopause is when a woman is no longer biologically able to ovulate and is essentially the end of the child-bearing phase of a woman’s life. This is confirmed when a woman has no vaginal bleeding for 12 consecutive months. When women are transitioning into menopause, it is called perimenopause, and this phase is generally around 45 and 55 years of age. In North America, on average, 50% of women reach menopause at 52 years of age and 90% of women have reached menopause by 55 years of age.During perimenopause, many changes happen that can affect a woman physically and emotionally. Symptoms such as hot flashes, night sweats, mood swings, difficulty in concentrating or memory problems, weight gain, and vaginal dryness may start to develop, and the severity of each symptom is different for everyone. Frequency of periods also start to change and become irregular, with some periods heavier or lighter than others, and it may be harder to predict when the next period will happen.Reproduction:A woman is born with about 1 to 2 million immature eggs and as she ages, that number declines. During a woman’s lifespan, only about 400 to 500 eggs become mature and are released from the ovaries (called ovulation), where they can be fertilized and produce babies. However, not all menstrual cycles will cause ovulation.On average, women only have 300 to 400 immature eggs remaining at menopause and due to hormonal changes, the eggs eventually stop maturing and menstrual cycles stop. Therefore, if a woman is still experiencing menstrual cycles, even at irregular intervals, there is potential for pregnancy.How do Contraceptives Work?Contraceptives like hormonal birth control add extra estrogen and/or progesterone to a woman’s menstrual cycle, thereby preventing ovulation. It can also thicken vaginal fluids, making it difficult for sperm to move, and it thins the uterine lining, preventing a fertilized egg from attaching to the uterus.Hormonal birth control does not delay menopause. Menopause is a natural part of aging; a woman’s eggs will still deteriorate, and the number of eggs will still decline, even if birth control is preventing ovulation each month.Non-hormonal birth control, like condoms or diaphragms, prevent sperm from meeting an egg and copper IUDs make the uterus too acidic for sperm or eggs to survive.Withdrawal Bleed vs. Menstrual BleedTrue menstrual bleeding occurs if an egg is released from the ovary, but it does not get fertilized by a sperm. Hormonal changes then cause the lining of the uterus to shed, and the woman experiences bleeding that lasts between 2 to 7 days.Withdrawal bleeding occurs when a woman takes a break during short-acting hormonal birth control (like tablets, the patch, or the vaginal ring), resulting in a drop in estrogen and progesterone levels, causing the uterus to shed and bleeding occurs. For this reason, a woman taking hormonal birth control cannot use the presence of a withdrawal bleed to confirm if she is still fertile because ovulation did not occur, and bleeding is the result of a drop in hormone levels.Hormone Replacement Therapy (HRT)HRT is different than birth control as it contains much lower levels of estrogen and progesterone and is used to replenish what the body no longer makes for itself at menopause.HRT dosing is based on symptom improvement, not bloodwork, with close monitoring and follow-up with healthcare providers. Typically, treatment is started at a low dose and increased slowly to the lowest effective dose that will manage menopausal symptoms while minimizing the risk of side effects.Switching from Birth Control to Hormone Replacement TherapyIf a woman is sexually active, stopping birth control too soon may result in an unintended pregnancy and irregular bleeding. The Center for Disease Control (CDC), the American College of Obstetricians and Gynecologists, and the Menopause Society recommend that hormonal contraceptives be used until the average age of menopause (52 to 55 years old). If a woman decides to stop birth control, barrier methods, like condoms, should be used to prevent pregnancy until menopause is confirmed.Some women may want or need to take HRT to manage menopausal symptoms or maintain bone health. Each woman’s experience with HRT is different: some find that it works wonderfully, while others complain of severe mood swings. A 12-week trial should help determine if the chosen method is effective. Non-hormonal prescription medications and non-prescription products are also available to help manage symptoms.Making a DecisionThere is no right or wrong answer on when to stop birth control and transition to HRT and it is different for everyone. Your healthcare provider or London Drugs pharmacist can explain the risks and benefits of different options and a thorough discussion should occur before any treatment options are decided.Related
