Perimenopausal women continue to need birth control. They are at risk of pregnancy but also may have menstrual related problems that can be treated with birth control pills. Even though these products were initially designed for birth control, there are many noncontraceptive indications and benefits.

Traditionally when we refer to birth control pills, we mean the estrogen/progestin combination pill. There are currently many pills on the market with variations in the dose and other differences. All pills have the estrogen, ethinyl estradiol but differ by the type of progestin they contain. The dose of estrogen tends to range from 20-35 micrograms per pill. There are only a few types with higher doses. There are many different types of progestins and this tends to distinguish the different brands. A pill pack typically has 21 active pills and 7 days of inactive pills. These inactive pills do not contain any medication and this is when menstruation will occur. The different brands may have the same dose of estrogen and progestin in all of the 21 active pills or the dose of the hormones may vary every 7 days.

Contraceptive technology has provided us with newer alternatives for contraceptive delivery. Estrogen/progestin combination contraception can also be delivered by other means. Orthoevra is a brand that delivers the hormones through the skin. The patch is changed weekly. Leaving the patch off for 7 days on the 4th week then allows a period. The Nuvaring is designed for intravaginal delivery. The ring is worn for 3 weeks in a row and removed the 4th week to allow menstruation.

The most exciting change in the pill design are available in the new formulations of Yaz and Loestrin 24 Fe. They have 24 days of active pills with 4 days of inactive pills. This change decreases the side effects of pain, headaches, breast tenderness and bloating that tends to occur during the 7 pill free days of other pills. It is possible to take the pills in a continuous fashion and have a period when you are ready. Seasonale and Seasonique are 2 brands that simplify this process. 84 active pills are taken in Seasonale allowing a period 4 times a year. Seasonique is similar except there are 4 inactive pills rather than 7.

New formulations of estrogen/progestin contraceptives are safer and much more tolerable than the brands initially introduced more 40 years ago. Healthy women can continue to use them until they reach menopause. There are however some risks and side effects that are important to know. In addition there are cases where the pill is contraindicated and other contraceptive options are better suited. These issues will be addressed in upcoming articles.