What’s the best birth control to treat perimenopause symptoms?

In this article:

• What is perimenopause?
• Can birth control help with perimenopause?
• Best birth control for perimenopause
• Who is a good candidate for treatment?
• Alternate management strategies

In this article

• What is perimenopause?
• Can birth control help with perimenopause?
• Best birth control for perimenopause
• Who is a good candidate for treatment?
• Alternate management strategies

For many women, perimenopause marks a major turning point, the bridge between the reproductive years and menopause. As estrogen levels fluctuate, symptoms like hot flashes, irregular menstrual periods, and mood changes can disrupt daily life. While it’s easy to think of this midlife transition as a time to leave birth control like barrier methods and copper IUDs behind, hormonal contraceptives can actually be one of the most effective tools for managing perimenopause symptoms.

Here, experts share how certain birth controls can help smooth out hormone fluctuations, reduce discomfort, and support your quality of life during this stage. You’ll also learn about the best types of birth control for perimenopause and additional lifestyle strategies to help you feel more like yourself again.

Understanding perimenopause

“Perimenopause is a transition period into menopause when we see changes to the menstrual cycle and hormones associated with the cycle,” explains Alissa Floman, MD, a board-certified OB-GYN with WREN Obstetrics, Midwifery, and Gynecology in Gilbert, Arizona. “Typically, your hormones are in a state of fluctuation, specifically estrogen and progesterone, which can lead to a myriad of symptoms.”  After menopause, your ovaries make very low levels of the hormones called estrogen and progesterone.

Cycle changes are the earliest and most noticeable sign that perimenopause has begun. Per The Menopause Society, you could experience more or fewer menstrual bleeding days or a heavier or lighter flow, unpredictability, and the length of your cycle will start to vary.

Research shows that perimenopause typically lasts four to seven years, while the average age of menopause in the United States is 52, according to the Office on Women’s Health. That means that for most women, perimenopause will start in their 40s, though some do see changes earlier.

“Perimenopause is a time of hormonal volatility. Ovulation and the predictable peaks and troughs of estradiol and progesterone can be irregular and less orchestrated,” explains Alyssa Dweck, MD, the Chief Medical Officer of Bonafide Health and Menopause Society Certified Practitioner. This can lead to many symptoms on top of an irregular menstrual cycle, Dr. Dweck adds. They include:

• Hot flashes
• Night sweats
• Sleep disruption
• Mood changes
• Irritability
• Brain fog
• Headaches
• Weight gain
• Vaginal dryness
• Low sex drive

Does birth control help with perimenopause symptoms?

“The first-line treatment of perimenopausal symptoms is some type of hormone therapy,” Dr. Floman says. Considering that hormonal birth control contains estrogen or progesterone, it fits the bill. “Especially combination varieties (like pills, patches, and vaginal rings) containing estrogen and progesterone prevent ovulation and keep estrogen and progesterone levels stable throughout the cycle,” Dr. Dweck explains. The progesterone shot, hormonal IUD, and hormonal implant contain progesterone only and can also help with perimenopausal symptoms. “The lack of hormone volatility on combination contraception helps to manage typical perimenopause symptoms, including irregular menses. In fact, menses can be skipped altogether with continuous administration; in other words, skipping placebo pills.”

A review in Gynecological and Reproductive Endocrinology & Metabolism found that, in addition to cycle-related symptoms like irregular bleeding, combined hormonal birth control also helped with vasomotor symptoms (like hot flashes and night sweats), which are some of the most common issues women experience during perimenopause. Dr. Dweck adds that combination birth control pills can also lower your risk of fatigue, lightheadedness, and weakness from heavy bleeding, pain during your cycle, mood swings, and changes to your skin and hair.

Finally, birth control will do what it was designed to do. “There is still a concern during perimenopause of pregnancy,” Dr. Floman says. “So we primarily choose these options with women seeking contraception needs in addition to treatment of perimenopausal symptoms.”

What is the best birth control for perimenopause symptoms?

“The type of contraceptive is very individualized as to personal preference, health concerns, lifestyle, tolerance, and symptoms,” Dr. Floman says. Hormonal birth control can contain both estrogen and progesterone (combination methods) or just progesterone. Both of which can be effective for controlling perimenopause symptoms, but your medical history may determine which form of birth control is best.

Combination birth control (estrogen and progesterone): 

• Includes contraceptive pills, patches, and vaginal rings
• Helps stabilize hormones and regulate cycles
• May improve PMS-type symptoms, mood, and skin
• May protect bone density and protect against osteoporosis
• Not recommended for women who smoke, have hypertension (high blood pressure), migraine with aura, a history of blood clots, or are at high risk of breast cancer

Progesterone-only birth control:  

• Includes the hormonal intrauterine device (IUD), implant, shot, and certain birth control pills
• Best suited for those who can’t take estrogen
• Can help reduce heavy bleeding and protect the uterine lining
• Do not improve vasomotor symptoms
• Do not protect bone density or prevent osteoporosis

“Progesterone-only pills are best for those who have hypertension or who smoke,” or have a history of blood clots, stroke risk, migraine with aura, or high risk of breast cancer, Dr. Dweck says. They are also known as mini-pills or low-dose pills.

Within those two types of birth control, there are also different forms of estrogen and progesterone that are used. “Some varieties of progesterone are less androgenic (male hormone-like) and also best for PMS-type symptoms, common during perimenopause,” Dr. Dweck says. “There is also a new estrogen now available in combination pills (drospirenone-ethinyl estradiol), which claims to have a better cardiovascular risk profile and less effect on breast tissue,” if those are concerns for you.

Who is a good candidate for birth control during perimenopause? 

There are a few key factors that your healthcare provider would consider when determining if you are a good candidate for birth control during perimenopause. According to Dr. Dweck, the criteria that would make you a good candidate include:

• You need or want contraception for family planning
• You want better cycle control or help with symptoms related to your cycle
• You struggle with premenstrual syndrome-type symptoms
• You have no medical contraindications or risk factors to hormonal birth control

Hormonal replacement therapy (HRT) vs. birth control pills for perimenopause

If you’re even vaguely familiar with common menopause treatments, you’ve likely heard of hormone replacement therapy, or HRT. Just like hormonal birth control, HRT (which is also often called menopausal hormone therapy, or MHT, or just hormone therapy, or HT) uses estrogen and progesterone to control symptoms that women experience during this transition. 

Both therapies balance hormones, but they’re designed for different life stages and goals.

Key differences between HRT and birth control
Feature	HRT	Hormonal contraceptive
Purpose	Manages menopause symptoms (e.g., hot flashes, vaginal dryness, GSM)	Prevents pregnancy and helps regulate cycles
Hormone levels	Lower-dose estrogen and/or progesterone	3–4 times higher estrogen than HRT, in various forms. Or progesterone only.
Best for	Women between 55 and 60, within 10 years of their last period	Perimenopausal women younger than 55 and also need contraception
Cycle control	May not regulate cycles as effectively	Excellent for managing irregular bleeding
Pregnancy prevention	Does not prevent pregnancy	Prevents pregnancy
Forms available	Pills, patches, gels, vaginal rings, creams	Oral contraceptives, patches, vaginal rings, IUDs, shots, implants
Examples	Angeliq (combination estrogen/progestin tablet) Estradiol patch or gel Progesterone capsules	Yaz (combination pill) Norethindrone (progestin-only pill) Mirena IUD (long-acting, up to 8 years)

Dr. Dweck adds that birth control tends to work better for cycle control and prevents pregnancy, while HRT is a better fit for women who’ve been in perimenopause longer or experience side effects from contraceptives.

Other strategies for managing perimenopause

The gold standard of care for perimenopause symptoms is hormone supplementation like birth control, Dr. Floman says. “It is always necessary to include lifestyle changes, … as there is not one type of therapy that completely helps with all symptoms,” she adds. 

• Make lifestyle changes: A review in the American Journal of Lifestyle Medicine found that a Mediterranean diet and other plant-based diets, combined with moderate-intensity exercise and strength training, are the most effective lifestyle changes for managing symptoms of perimenopause. “For some women, different types of bed cooling systems can add to their toolbox,” Dr. Floman says.
• Explore dietary supplements:  “There are also many over-the-counter supplements women can find helpful and other prescription medications which treat various symptoms,” she adds. According to Harvard Medical School, if you decide to try a supplement such as black cohosh or red clover, choose one that is third-party tested and contains only one ingredient, rather than a mixture of several. 
• Consider natural estrogens: Eating a diet rich in plant-based, or phytoestrogens, can also support a healthy hormone balance. Try incorporating foods like flaxseeds, lentils, broccoli, garlic, and tea into your diet.
• Partner with your healthcare provider: If you are struggling with mood swings or depression, you could talk to your healthcare provider about prescribing an antidepressant. Ultimately, the best thing you can do is maintain open communication with your healthcare team about your symptoms and concerns. 

That way, you can work together to create a personalized treatment plan that has the best chance of working for you while minimizing unnecessary health risks.