HRT vs. Birth Control for Perimenopause: What’s Best for You?

Can You Take the Pill and HRT Together?

In most cases, you should not take the birth control pill and HRT at the same time.

Both treatments contain estrogen and progestin, but combining them can lead to excessive hormone levels, increasing the risk of blood clots or other complications.

That said, there are exceptions. Some women may use the pill in their late 40s and then transition to HRT once they stop ovulating regularly. A healthcare provider can help guide this shift to ensure your symptoms are managed without overlapping hormone exposure.

Does HRT Work as Birth Control?

No—HRT does not prevent pregnancy. Although HRT contains estrogen and sometimes progestin, the doses are too low to suppress ovulation, which is necessary for birth control. If you are still in perimenopause and sexually active, you can still get pregnant, even with irregular or infrequent periods.

Women should continue using contraception until they’ve gone 12 months without a period (which marks the official start of menopause). After that, birth control is no longer necessary.

What Contraception Is Best While on HRT?

If you’re taking HRT and still need contraception, it’s important to choose a method that complements your hormone therapy without adding unnecessary risk.

The most effective contraception options while on HRT include copper IUDs, which are hormone-free and long-lasting; hormonal IUDs, which deliver a low dose of progestin locally and pair well with estrogen-only HRT; and the progestin-only pill (also known as the mini-pill). Barrier methods like condoms or diaphragms are also safe and hormone-free. For those who do not wish to get pregnant again in the future, permanent options like tubal ligation or vasectomy are also common and highly effective.

It’s best to avoid combined hormonal contraceptives (like traditional birth control pills) alongside HRT unless prescribed by a doctor for a specific reason.

What contraception should I use during perimenopause and menopause?

During perimenopause, fertility declines but doesn’t disappear. Therefore, if you’re trying to avoid getting pregnant, you will still need to use contraception. The right option depends on your age, medical history, and whether you’re also managing menopause symptoms.

If you’re under 50 and still having periods, a low-dose birth control pill may be ideal for both symptom relief and contraception. If you’re transitioning off the pill and onto HRT, methods like the hormonal IUD or mini-pill can bridge the gap. If you’re close to menopause, non-hormonal options or permanent contraception may be most appropriate.

Once you’ve gone 12 months without a period, you’re considered menopausal, and contraception is no longer needed. At that point, you may continue HRT for symptom management alone.

Conclusion

Deciding between the birth control pill and HRT for perimenopausal symptoms depends on your age, symptom severity, and whether you still need contraception. The pill may be ideal for women in their 40s who need both symptom relief and pregnancy prevention. HRT is typically better suited for women who are postmenopausal or no longer ovulating regularly.

You should not take both the pill and HRT together unless directed by a provider. And remember: HRT does not prevent pregnancy, so you’ll need to use an alternative birth control method besides the pill.

To determine what’s right for you, talk to a healthcare provider who understands hormonal transitions and can personalize your treatment plan. With the right approach, you can manage your symptoms and protect your reproductive health during this important life stage.