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    Response to 51 and still on the pill
    Cynthia A Stuenkel, MD, NCMP posted:
    We are from the generation of women who grew up in the early wave of oral contraceptive (OC) use, so I suspect your question is relevant to many. One of the ways OCs work is by suppressing or shutting down the signals from the pituitary gland to the ovaries, so monthly ovulation usually does not occur. OCs provide plenty of hormones, so there is no shortage of estrogen and some form of synthetic progestogen to make up for the lack of hormone production by the ovary.

    The question is what's happening to the eggs within the ovary during those years on OCs? Is the ovary somehow "hibernating"? Do 30 years of OCs mean that menopause occurs 30 years later? It appears that aging of the eggs within the ovary continues to occur despite the absence of pituitary hormone stimulation. So, the best evidence we have right now is that menopause probably occurs close to the normal anticipated age even in women taking OCs (age 51).

    While you're taking them, however, contraceptives mask the symptoms of menopause. The hormone content of even low-dose OCs is about 4 to 8 times stronger than the doses of postmenopausal hormone therapy (HT) that we now recommend. That's more than enough estrogen to prevent hot flashes and vaginal dryness, the common symptoms of menopause. And you still have monthly bleeding on the pill. That's why you only experience menopause symptoms during the week you are off the pill.

    Postmenopausal HT, with few exceptions, uses different types of hormones than those included in OCs. Most clinicians initiate the conversation about switching off OCs around age 50. Again, women differ in their risk profiles, so the decision to stop or switch is an individual one. In healthy, nonsmoking women, some clinicians will continue low-dose OCs until age 55. If you elect to continue, you should talk with your clinician about a plan to relieve your symptoms during the week off—either supplemental low-dose estrogen or change to a continuous schedule of the pills. Given that risks of any hormone treatment (including the pill) increase with age, it's probably a good idea to at least review your personal risks, which might change during midlife, and discuss the pros and cons of switching from the pill to lower-dose postmenopausal HT or some other option for symptom relief.

    Remember to use barrier contraception until you're certain you're fully postmenopausal (usually a year without periods or consistent elevations of the pituitary hormone, FSH, on blood tests). Postmenopausal HT is not potent enough to suppress pituitary hormones and prevent ovluation like the pill does; thus, HT does not provide contraception.

    Good luck!
    An_205834 responded:
    Thanks so much for your response!

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