Birth control pills for dysfunctional uterine bleeding and perimenopausal symptoms

Examples

Generic Name	Brand Name
Very low-dose pills	Alesse, Minestrin 1/20
Low-dose pills	Min-Ovral, Yasmin
Phasic pills	Ortho 7/7/7, Ortho Tri-Cyclen Lo, Triphasil
High-dose pills	Demulen 1/50, Norinyl 1/50, Ovral

How It Works

Birth control pills, which are also called oral contraceptives, regulate the body's estrogen and progesterone levels. You take birth control pills every day. Birth control pills:

• Prevent the ovaries from releasing an egg every month (ovulation). This prevents pregnancy.
• Minimize growth of the uterine lining, called the endometrium. This reduces or stops dysfunctional uterine bleeding (thick endometrial growth leads to heavy bleeding).
• May cause you to have fewer menstrual periods if taken continuously for a long period of time.
• May improve perimenopausal symptoms that are caused by fluctuating hormone levels.

Why It Is Used

Birth control pills are commonly used to:

• Stop a teen's irregular menstrual bleeding (dysfunctional uterine bleeding) and regulate her cycle.
• Regulate a perimenopausal woman's irregular periods (dysfunctional uterine bleeding).
• Regulate perimenopausal hormone levels, with the intention of reducing hormone-related symptoms while providing effective birth control.^{1, 2}
• Regulate a woman's menstrual cycles that have been chronically irregular.

How Well It Works

The endocrine system, which produces hormones, is complex and not fully understood. Therefore, as with any hormone treatment, birth control pills do not reduce symptoms in all women. They cause troublesome side effects in some women, but not others. If you have problems with ineffectiveness or side effects, ask your health professional whether a different hormone formulation may work better.

Dysfunctional uterine bleeding. Birth control pills reduce heavy menstrual bleeding by about 60%.³

Perimenopausal symptoms. Birth control pills reduce or eliminate hot flashes and improve sleep problems and depression in most perimenopausal women, while effectively preventing pregnancy.^{2, 4} Studies report a range of 65% to 100% of women gaining partial to full relief from hot flashes when using birth control pills.²

Disease prevention. The estrogen in birth control pills maintains or improves bone density (osteoporosis prevention) during perimenopause, when bone loss begins to increase.² Long-term use (4 or more years) of birth control pills helps preventendometrial cancer and ovarian cancer. Experts suspect that progestin is the protective factor.⁵

Recurrence

When you stop taking birth control pills, dysfunctional uterine bleeding or perimenopausal symptoms may return.

Side Effects

Side effects of birth control pills are generally the most severe during the first few months of use and then gradually subside. The most common side effects are:

• Breast tenderness.
• Nausea.

Although some women report weight gain with birth control pill use, studies suggest that generally, long-term weight gain is not a common side effect.²

The risk of serious side effects increases in women who smoke.

Rare, but more serious, side effects include:

• High blood pressure.
• Blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism).
• Heart problems.
• Possible increased risk of cervical cancer.

If you have serious side effects, call your health professional for immediate follow-up.

If you have bothersome side effects, report them to your health professional at your next regularly scheduled visit.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Do not use birth control pills if you:

• Are older than 35 and smoke, have complications from diabetes, or have an increased risk of heart disease.
• Have a personal history of breast cancer. Estrogen stimulates certain types of breast cancer.
• Have uncontrolled high blood pressure.
• Have liver disease.
• Have a history of blood clots in a vein (deep vein thrombosis) or lung (pulmonary embolism).
• Have a history of stroke.

For women older than 35, low-dose birth control pills are recommended. If you have no risk factors, such as a history of heart problems or stroke, you may use birth control pills until menopause is completed. Birth control pills are not recommended for use after menopause.

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Author:	Merrill Hayden Carrie Henley	Last Updated: May 18, 2006
Medical Review:	Adam Husney, MD - Family Medicine Kathleen Romito, MD - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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