Reviewed by Dr. Kenton Bruice, MD
Reading time: three minutes
If your period shows up late, early, or not at all, and your mood swings and fatigue are becoming a pattern, you are likely facing the hormonal rollercoaster of perimenopause. With hormones in flux, figuring out the right treatment path can feel complicated.
Some doctors prescribe birth control pills to manage early perimenopausal symptoms, while others turn to hormone replacement therapy (HRT). So how do you know which option is right for you and when it might be time to make a switch?
In this blog, you will learn how both options work, when they are typically used, and how to know if it is time to transition from birth control to HRT.
Table of Contents
Key Takeaway
Birth control pills can help during early perimenopause, but if you are over 45 or done with contraception, it may be time to switch to hormone replacement therapy to better support your long-term health and reduce potential health risks.
Understanding Your Options in Perimenopause
Perimenopause brings unpredictable changes, including:
- Irregular periods
- Mood swings
- Fatigue
- Weight gain
- Night sweats or sleep issues
There is no one-size-fits-all treatment. Many perimenopausal women begin with birth control pills or hormonal IUDs. Others start directly with hormone replacement therapy. The right choice depends on your age, symptoms, and goals.
Learn more about perimenopause in this article: Understanding Peri-Menopause: Symptoms and Treatment.
Why Some Doctors Recommend Birth Control First
If you are in your late 30s or early 40s and still getting menstrual periods, even if they are irregular, your doctor may recommend oral contraceptives or a hormonal IUD.
These can help:
- Regulate bleeding to help reduce irregular bleeding and make your cycle more predictable.
- Control heavy periods to lower the risk of anemia and ease menstrual bleeding.
- Prevent pregnancy as fertility declines in perimenopause, but unplanned pregnancies remain a risk factor.
Birth control pills deliver foreign estrogens and progestin to suppress ovulation. It will lower natural estradiol and progesterone production thus it usually will not improve perimenopausal symptoms such as mood swings, sleep and memory.
Doctors often recommend the combined birth control pills for perimenopause. However, women in their forties have a significant risk of blood clots on birth control pills.
How HRT Is Different
Hormone Replacement Therapy (HRT) involves supplementing estrogen, progesterone and sometimes testosterone to relieve symptoms caused by declining hormone levels during perimenopause and menopause.
The focus is replacement, not suppression.
HRT is commonly used when:
- Perimenopausal symptoms like hot flashes, sleep issues, or mood changes begin to interfere with daily life
- Periods become irregular or start spacing out
- You want support for bone, brain, or cardiovascular health as estrogen levels shift
- You are no longer using hormonal birth control for contraception
Unlike oral contraceptives, HRT is typically prescribed in doses tailored to your age, symptoms, and stage of reproductive aging. It is used to reduce symptoms such as hot flashes, night sweats, and sleep disturbances, and to help maintain bone density and reduce the risk of osteoporosis. When initiated near the time of menopause, HRT may also offer benefits for mood, cognitive function, and cardiovascular health.
Bioidentical Hormone Replacement Therapy
Bioidentical hormone replacement therapy (BHRT) is a form of HRT that uses hormones structurally identical to those your body naturally produces. These include estradiol, progesterone, and sometimes testosterone.
Dr. Bruice specializes in BHRT because it allows for more precise hormone balancing based on your symptoms, goals, and stage of life. BHRT can be delivered through FDA-approved prescriptions or compounded formulations when a more customized approach is needed.
Some women prefer BHRT because it more closely mirrors the body’s natural hormone chemistry and can offer a tailored experience based on individual needs. For those who have not responded well to conventional HRT, or who want a more personalized dosing strategy, BHRT may be a better fit. With proper evaluation and ongoing monitoring, BHRT can provide effective relief from symptoms while supporting long-term health.
Learn more about this type of hormone therapy in this article: BHRT in St. Louis, MO: A Personalized Approach to Women’s Hormone Therapy.
Birth Control vs. HRT: Key Differences
To better understand how these two options differ, here’s a quick comparison of birth control and hormone replacement therapy based on how they work, when they’re used, and what they’re designed to do.
Factor | Birth Control | HRT |
Type of hormones | Synthetic | Synthetic or Bioidentical (BHRT) |
Goal | Suppress ovulation | Replace declining hormones |
Prevents pregnancy | Yes | No |
Used during | Early perimenopause | Perimenopause & menopause |
Custom dosing | No | Yes, tailored to you |
When to Reevaluate Your Approach
Hormonal contraception is not meant to be a long-term solution for managing perimenopausal symptoms. It may be time to switch to HRT if you:
- Are over 45 and notice new perimenopausal symptoms like sleep disruption, night sweats, or hot flashes
- No longer need contraception
- Want a more personalized approach to hormone balance
Talk to a Hormone Doctor in St. Louis
Dr. Kenton Bruice offers personalized care for women in perimenopause and menopause. He specializes in balancing hormones with bioidentical hormone therapy and has helped hundreds of women reduce symptoms, restore energy, and feel like themselves again.
You will get a customized plan, whether it means staying on your current method or transitioning to BHRT with tailored dosing based on your symptoms, goals, and current hormone levels.
To book an appointment with Dr. Bruice at the St. Louis Hormone Institute of Missouri, call (314) 222-7567 or visit us at 9909 Clayton Rd, Suite 225, St. Louis, MO.
Other locations