Q: I’m 48 and on the pill. I feel fine, but I’m wondering whether I may already be menopausal and therefore no longer need the pill. When do I know it’s time to stop taking it?
A: A simple blood test can tell you.
The birth-control pill overcomes your natural hormonal status, so you won’t go through the symptoms of perimenopause and menopause, such as irregular cycles, accelerated PMS, hot flashes and mood swings.
The average age of menopause is 51.7 years. If you were my patient and had no particular reasons for continuing on the pill (high blood pressure, blood clots or an estrogen-related cancer), I would have you stay on the pill until you are 51 and then take a two-week break.
At the end of the second pill-free week, when the pill’s hormones are out of your system, I would draw your blood to check for levels of FSH (follicular stimulating hormone).
The reason for doing this is that when the ovaries quit producing estrogen, the pituitary gland tries to compensate by putting out more FSH. Consequently, looking at FSH, not estrogen, is how we check ovarian function and determine whether you are menopausal.
If your FSH is not elevated, meaning you have not become menopausal, you can stay on the pill for about another year, after which your FSH can be tested again. During that year, the pill will provide both contraception and hormonal control for possible perimenopausal symptoms (such as the well-known hot flashes that often accompany the end of the childbearing years).
If your FSH is elevated, you are menopausal. You can stay off the pill and see what happens in terms of your period. You will probably get infrequent periods or none at all. (If you are having sex during this time, it is wise to use another form of birth control, such as a condom, in case it turns out that you are still capable of getting pregnant.)
Another factor to take into account is that the removal of the hormones present in birth-control pills can lead to post-menopausal symptoms such as hot flashes, night sweats, short-term memory loss or sleep problems. If this is the case, you may want to talk to your doctor about transferring to hormone-replacement therapy (HRT). (Click here to see my earlier article on this subject.)
One thing to keep in mind is that the hormones in the birth-control pill are five times more potent than those in HRT. The pill has enough hormone to prevent ovulation, whereas HRT simply replaces what’s missing. Although many women love the pill and don’t want to stop, staying on it for years after menopause is, from a hormonal viewpoint, overdoing it.
You don’t have to worry about taking the pill through your 40s and early 50s. There seems to be no added risk of breast cancer, and there is a decreased risk of endometrial and ovarian cancer.
Dr. Reichman’s Bottom Line: If you are still on the pill in your early 50s, stop for two weeks, have your doctor check your menopausal status and proceed accordingly.
Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You willl find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," published by William Morrow, a division of .
PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.