Summary: Hormonal Contraceptives for Managing Perimenopause

February 10th, 2025

Introduction

Hormonal contraceptives, particularly the levonorgestrel intrauterine device (LNG-IUD), can provide significant benefits to perimenopausal women by managing symptoms and preventing unintended pregnancies. Research highlights several advantages of hormonal contraception during perimenopause, including:

• Regulation of abnormal uterine bleeding
• Reduction of vasomotor symptoms (hot flashes, night sweats)
• Prevention of menstrual migraines
• Protection against bone loss and musculoskeletal issues
• Endometrial protection for women using estrogen therapy

These benefits improve quality of life and may prevent unnecessary medical interventions, such as biopsies and hysterectomies.

Hormonal IUD for Perimenopausal Bleeding

Irregular bleeding is a hallmark of perimenopause, sometimes mimicking symptoms of uterine cancer and necessitating biopsies. The 52 mg levonorgestrel IUD is particularly effective in:

• Reducing heavy menstrual bleeding
• Increasing rates of amenorrhea with prolonged use (up to eight years)
• Minimizing unnecessary cancer screenings and procedures

For obese women, who have a higher risk of endometrial cancer, the IUD provides additional protection against endometrial hyperplasia (abnormal thickening of the uterine lining).

Migraine and Hormonal Fluctuations

Hormonal fluctuations during perimenopause contribute to an increased frequency of menstrual migraines, especially those triggered by estrogen withdrawal.

• The LNG-IUD provides continuous progestogen release, which is preferred over cyclical progestogens that can worsen migraines.
• Evidence supports using the LNG-IUD in combination with estrogen therapy to stabilize hormone levels and prevent estrogen withdrawal-related headaches.

Combination Therapy: IUD and Estrogen

For women experiencing both irregular bleeding and vasomotor symptoms, combination therapy using a hormonal IUD and systemic estrogen is recommended.

• LNG-IUD helps protect against hyperplasia.
• Estrogen therapy (patch or oral) addresses hot flashes, night sweats, and bone health.
• The LNG-IUD offers an alternative to oral progesterone, which can cause systemic side effects like breast tenderness and joint pain.

This combination is effective off-label but is gaining acceptance due to its safety and efficacy.

Preventing Unintended Pregnancy in Perimenopause

Although fertility declines with age, women over 40 can still conceive. The miscarriage rate rises sharply in this age group, with an 80% risk for women over 40. Other concerns include:

• Higher rates of pregnancy complications
• Limited access to abortion care because of state restrictions, increasing the importance of contraception for health preservation

The LNG-IUD provides reliable long-term contraception while also managing perimenopausal symptoms.

Conclusion

Hormonal contraception, particularly the LNG-IUD, plays a crucial role in perimenopausal symptom management, providing non-contraceptive benefits such as bleeding regulation, migraine relief, and cancer prevention. When combined with estrogen therapy, it can effectively manage vasomotor symptoms while ensuring endometrial safety. Given the rising miscarriage risks and abortion restrictions, contraception remains an essential part of comprehensive perimenopausal care.

For more information on using hormonal contraceptives to manage perimenopause, click here.