Contraception as hormone therapy: What should you know?

Maybe this sounds familiar: you go to your GP with hormonal complaints and quickly get prescribed the pill. For many women, this has been the standard solution for years. Sometimes it works well, and other times it feels like your body just isn’t cooperating. Especially in perimenopause, this raises questions: is the pill really the best option, or are there other forms of hormone therapy that might be a better fit?

In this blog, we’ll walk through the key differences and considerations so you can make an informed choice about what works best for your situation.

Table of contents

1. Why contraception is often prescribed for hormonal symptoms

2. The difference between synthetic and bioidentical hormones

3. How does the pill work in perimenopause?

4. Risks and side effects of the pill

5. Alternative treatments and combinations

6. What to consider when making your choice

Why is the pill often prescribed?

The contraceptive pill was originally designed to prevent pregnancy. It works with synthetic hormones that bind more strongly or consistently to receptors than your own hormones. This makes it a very reliable form of birth control. Doctors also prescribe the pill for complaints such as heavy periods, PMS, or acne. In those cases, it can provide relief. But with perimenopausal symptoms, the picture becomes more complex: the pill is not necessarily the first choice. It’s important to remember that hormone therapy itself does not protect against pregnancy. If you’re still in your fertile years, you’ll always need a separate contraceptive solution.

Synthetic versus bioidentical hormones

Broadly speaking, there are two types of hormones used in pills or therapies:

• Bioidentical hormones have exactly the same structure as your body’s own oestrogen or progesterone. Your body recognises and uses them as if they were your own hormones. This often makes them easier to tolerate and more supportive for things like sleep, mood, and bone health.

• Non-bioidentical hormones (such as many progestins in the pill) don’t fully match your body’s own hormones. They bind to the same receptors, but in a slightly different way. That can cause not only the desired effect but also other, less helpful reactions - what we call side effects.

Not all progestins act the same. Some resemble testosterone and can worsen acne or hair growth, while others block testosterone and work differently. Which side effects you notice depends on the type of pill and on your individual genetics and biology.

How does the pill work in perimenopause?

During the transition years, your hormone levels fluctuate significantly. The pill can smooth out some of those swings, reducing issues like irregular cycles or heavy bleeding. But it doesn’t always work as intended: for some women, their natural cycle still “breaks through” the pill. Most contraceptive pills contain ethinylestradiol - a synthetic form of oestrogen that keeps the liver active for longer. This increases the risk of blood clots and can negatively affect libido. Some newer pills (like Zoely, Qlaira, and Drovelis) use bioidentical oestrogen, which the body recognises and uses more naturally. These can feel gentler, but they still contain a synthetic progestin, and the overall hormone dose is often higher than what’s actually needed during perimenopause.

Risks and side effects of the pill

Alongside its benefits, the pill also carries some risks and side effects:

• Side effects may include acne, weight changes, headaches, or mood swings.

• Breast cancer risk is slightly increased with long-term use of synthetic progestins, though the absolute numbers remain small.

• Blood clot risk is higher with pills containing ethinylestradiol, especially when taken orally.

• Impact on libido: synthetic oestrogen can reduce sexual desire.

This doesn’t mean the pill is always a poor choice, but it does mean it’s important to consider whether alternatives might better suit your symptoms and life stage.

Alternative treatments and combinations

If you want to manage perimenopausal symptoms while maintaining contraception, there are several options beyond the classic pill:

• Hormonal IUD combined with bioidentical oestrogen. This can provide reliable contraception while easing menopause-related symptoms.

• Transdermal hormone therapy (patches or gels with bioidentical oestrogen), combined with another form of contraception. This lowers the risk of blood clots and tends to be more supportive for libido.

• Bioidentical progesterone alongside oestrogen. This supports sleep, mood, and bone health without the increased breast cancer risk linked to synthetic versions.

For women who no longer need contraception, hormone therapy without the pill can be a gentler and more targeted option.

What should you consider when making your choice?

The key takeaway: contraception and hormone therapy are not one-size-fits-all. Every body responds differently, and the right choice depends on your age, health, symptoms, and preferences.

Good to know: progesterone does much more than support the uterus. There are receptors for this hormone in your brain, bones, and even your skin. That’s why bioidentical progesterone often provides wider benefits than synthetic versions.

Seek out a doctor or (peri)menopause specialist who listens and takes the time to walk you through the different options.

At Flouria, we offer a personalised care trajectory for perimenopause, including consultations with perimenopause experts and prescription of HRT. For more information, click here.

In summary: choose consciously, not automatically

Contraception can play a role in hormone therapy, but it’s not always the best solution in perimenopause. The difference between synthetic and bioidentical hormones can make a big impact on how you feel. Make sure you’re informed, and don’t default to the standard pill. From hormonal IUDs to transdermal therapy, there are multiple options - and the right choice is always personalised.

Key takeaways

• The pill is often prescribed for hormonal symptoms, but in perimenopause it’s not always the best fit.

• Synthetic hormones act differently than bioidentical ones and may cause more side effects.

• Bioidentical progesterone and transdermal oestrogen often have a more favourable profile.

• Alternatives like the hormonal IUD or hormone therapy without the pill can sometimes be a better match.

• A personalised consultation with a (peri)menopause expert helps determine what works for your body.

References:

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Alonso-Molero, J., Gómez-Acebo, I., Llorca, J., Lope-Carvajal, V., Amiano, P., Guevara, M., Martín, V., Castaño-Vinyals, G., Fernández-Ortiz, M., Obón-Santacana, M., Alguacil, J., Fernandez-Tardon, G., Molina-Barceló, A., Marcos-Gragera, R., Pérez-Gómez, B., Aizpurua, A., Ardanaz, E., Molina, A. J., Rodríguez-Cundín, P., Moreno, V., … Dierssen-Sotos, T. (2022). Effect of the use of prediagnosis hormones on breast cancer prognosis: MCC-Spain study. Menopause (New York, N.Y.), 29(11), 1315–1322. https://doi.org/10.1097/GME.0000000000002069

Moradinazar, M., Marzbani, B., Shahebrahimi, K., Shahabadi, S., Marzbani, B., & Moradinazar, Z. (2019). Hormone Therapy and Factors Affecting Fertility of Women Under 50-Year-Old with Breast Cancer. Breast cancer (Dove Medical Press), 11, 309–319. https://doi.org/10.2147/BCTT.S218394

Cohen, M. A., Edelman, A., Paynter, R., & Henderson, J. T. (2023). Risk of thromboembolism in patients with COVID-19 who are using hormonal contraception. The Cochrane database of systematic reviews, 1(1), CD014908. https://doi.org/10.1002/14651858.CD014908.pub2