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TIDBSI: OCP Myths

Vanessa Gervais, MD and Adrien Selim, MD
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In this Things I Do But Should I segment, Adrien and Vanessa tackle some commonly held misconceptions about oral contraceptive pills. It’s one segment of an ongoing series on OCPs, inspired by questions from our listeners.

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Rose W., PAC -

You discussed that premenopausal women can take ocp (mentioned up to age 50-55). But, how do I know WHEN they get menpopause IF on pill the whole time. I'm sure they won't want to check, d/t sx of menses itself. Also, what about menopause use for menopausal symptoms? If menopausal sx lastly up to age 60 or 65, do they have to be removed? Recourse otherwise?

Adrien Selim -

Hi Rose, this is a great question!
Unfortunately there is no way to know for certain when a woman has definitively reached menopause, especially if taking an oral contraceptive in continuous fashion. Serum FSH levels are unreliable in women taking OCPs, so they are not helpful in this situation.

However it is reassuring to remember that the possibility of pregnancy is extremely low after age 50 (less than 1%), and most sources do recommend an attempt at withdrawing the OCP at around age 50-51 years.

The best way to handle this, in my opinion, is to have a conversation with you patient to discuss her options.
You can:
1) withdraw the OCP abruptly and completely and observe for the recurrence of menses (meaning the patient has not yet reached menopause, and then restart the OCP if desired). If the patient experiences significant vasomotor symptoms you can consider starting traditional HRT at this point. The reason for switching to conventional HRT over continued OCP use is that even low dose OCPs contain significantly more estrogen and progesterone than HRT, and therefore add unnecessary health risks.
2) taper the OCP by 1 pill every week or so to ease any possible estrogen withdrawal symptoms, or
3) switch directly to a conventional menopausal hormone replacement therapy regimen. (I don’t personally recommend this as you can’t be certain the patient actually requires the HRT for suppression of vasomotor symptoms since she wouldn’t have had the chance to even experience any yet).
But bottom line there is no role for continued OCP use beyond menopause (at least not at this time). Lower dose HRT provides ample hormone to eliminate vasomotor symptoms, whereas an OCP would be unnecessarily excessive and risky.
I hope that answers your question!
Sincerely,
Vanessa Gervais.

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Hello, New Year! Bye Bye, PPIs? Full episode audio for MD edition 201:19 min - 94 MB - M4APC RAP January 2019 Written Summary 386 KB - PDF

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