Get Healthy Without Feeling Overwhelmed

Time for a Q&A to answer your questions about:

• Do progesterone-only birth control pills help with perimenopause symptoms?

• How can I get healthy without getting overwhelmed?

Enjoy! And remember, please submit any question you’d like answered here.

Q: You often talk about birth control pills as hormone therapy. Does that only work with pills that have estrogen in them? What about using progesterone-only pills during early perimenopause? How does that compare with using combination birth control?

—Anonymous

A: The answer to this question depends on a couple of factors. The first question is, what symptoms are you hoping to treat? The second is, which progesterone-only pill should you take? To fully understand how to answer these questions, it’s helpful to understand how the progesterone-only pill works.

Combination pills that contain estrogen and progesterone work as contraception by suppressing ovulation. But suppressing ovulation and providing a nice stable dose of estrogen and progesterone is also why combination pills can be helpful for managing perimenopausal symptoms.

The progesterone-only pill Slynd (drospirenone 4 mg) suppresses ovulation, but other progesterone-only pills don’t reliably suppress ovulation. Instead, they prevent pregnancy by thickening cervical mucus, reducing the endometrium’s receptivity to implantation, and making it harder for sperm to get into the fallopian tubes to fertilize an egg.

When you are looking to manage symptoms related to the rise and fall of estrogen and progesterone, like premenstrual dysphoric disorder, a progesterone-only pill like Slynd could be helpful—though it’s worth noting Slynd hasn’t been tested specifically for this use. However, a progesterone-only pill may not be helpful with estrogen-related symptoms like hot flushes and night sweats. Simply put some perimenopausal symptoms are managed by reducing menstrual cycle hormonal fluctuations, others are improved by estrogen directly.

There are situations in which progesterone-only pills could be useful as one component of hormone therapy. If a woman could not take estrogen in pill form or just prefers estrogen in a patch or gel, but still wanted contraception, Slynd would be an excellent alternative to progesterone pills. Similarly, if a woman were having breakthrough bleeding with an estrogen patch plus a progesterone pill, subbing out the progesterone pill for Slynd could be helpful.

The Savvy Short: While progesterone-only pills alone may not be ideal for managing perimenopausal symptoms, pills like Slynd that work by suppressing ovulation are useful as one component of hormone therapy.

Q: I am a 40-something-year-old woman. I want to be healthy, but I feel like the list of things I should do is so long that I get overwhelmed. How can I manage my health without becoming obsessed or stressed by the “should”?

—Overwhelmed