11 Jan 2018
It’s Time to Stop Using Birth Control Pills to Manage Perimenopause
If you’re on birth control pills to manage perimenopause symptoms, it may be time to rethink that choice.
A recent study, which followed 1.8 million Danish women for more than a decade, upends what we’ve been told about modern contraceptives (including IUDs). Many women (and their doctors) believe that newer generation birth control is safer than what was available when the Pill was first used.
The new paper estimated that for every 100,000 women, hormone contraceptive use causes an additional 13 breast cancer cases a year. That is, for every 100,000 women using hormonal birth control, there are 68 cases of breast cancer annually, compared with 55 cases a year among nonusers. And the risk increases with age.
While a link had been established between birth control pills and breast cancer years ago, this study is the first to examine the risks associated with current formulations of birth control pills and devices in a large population.
Until recently, estrogen was widely assumed to be the “bad actor” when it comes to birth control pills or hormone replacement therapy. This research supports more the more recent realization that it’s the synthetic progestin that is the problem. This finding supports the conclusions from the 2002 Women’s Health Initiative study. Synthetic progestins are the common link between combined hormone contraceptives, progestin-only pills and hormone-releasing IUDs.
The study also found that the risk increased the longer women used contraceptives involving hormones. Women who stayed on hormones for 10 or more years experienced a 38 percent increase in their relative risk of developing breast cancer, compared with nonusers. The risk persisted even after hormones were stopped. There was no increased risk for breast cancer seen in women who used hormones for less than one year.
A 20 percent increase in relative risk may be small in absolute terms, but the calculation changes with age. For a 20-year-old woman, for example, the probability of developing breast cancer in the next 10 years is .06 percent, or 1 in 1,732, according to breastcancer.org.
Even if the relative risk increases 20 percent, it remains less than one-tenth of 1 percent. But by the time a woman reaches 40, her probability of developing breast cancer in the next 10 years is 1.45 percent, or 1 in 69. A 20 percent increase raises her risk to 1.74 percent, or 1 in 57.
Why are these findings important?
These findings are important not only because many perimenopausal women are still using birth control pills for contraception but because it’s a widely used approach to manage perimenopausal symptoms of hormone imbalance.
These numbers are small in the big picture, but this new data does beg the question… Why take the risk if you don’t have to? Especially if it’s being used as a Band-Aid in perimenopause?
Yes, it’s easier and faster to write a prescription that will shut down all hormone production than it is to take the time to discuss all the alternatives. But this does women a disservice by creating another potentially deadly problem.
It’s understandable if a woman is having severe bleeding that puts her health at risk from anemia and can’t be controlled with other approaches like bio-identical progesterone, but it’s another matter if birth control pills are being used to control acne, hot flashes and other bothersome (but not life-threatening) symptoms. Why not get to the root of the problem and manage the underlying hormone imbalance?
Here’s the bottom line for those of you who are not data geeks (and those of you who may be inclined to hit the panic button):
- The increase in risk is very small
- These findings do NOT apply to BHRT or bio-identical progesterone
- You are not “dead man walking” (as one of my Hormone Harmony Club members described herself) if you’ve taken birth control for longer than 10 years
- If you’re on birth control pills, consider having a talk with your doctor about other options
- Work on safer alternatives to hormone balance before choosing birth control pills
Dr. Anna Garrett is a menopause expert and Doctor of Pharmacy. She helps women who are struggling with symptoms of perimenopause and menopause find natural hormone balancing solutions so they can rock their mojo through midlife and beyond. Her clients would tell you that her real gift is helping them reclaim parts of themselves they thought were gone forever.
Find out more about working with her at https://www.drannagarrett.com/work-with-me/.