I Stopped the Pill and Feel Awful. Is this Menopause?

Ask Dr. Jen

I’m 50 and I stopped the pill a few months ago. My period hasn’t restarted and I feel awful. I’m hot, my heart is racing, and I have joint pains. Is this menopause? 

- Via Facebook

Quick Take

Most likely. Going from the “estrogen high” of the pill to menopause essentially overnight can produce worse symptoms for some women. There are therapies to help, so you don’t have to suffer. 

Go on...

Technically, menopause is the last menstrual period. The years leading up to the final period are the menopause transition and afterwards is postmenopause. We don't know if someone is postmenopausal until one year after the last period. Taking the birth control pill with estrogen (aka the combined oral contraceptive) suppresses ovulation and impacts the menstrual period-as-menopause-indicator. Women who take the pill regularly, meaning they have a pill free or placebo week, get a period each cycle due to withdrawal of the hormones and they will continue to have this bleeding each cycle even when they are menopausal. Women who skip the placebo week (meaning they take an active pill with hormones every day of the month) typically have no menstrual periods, so there will be no period to track. In addition, the estrogen in the pill typically prevents some of the hormone changes that cause symptoms of menopause.

With the progestin only pill that contains norethindrone (also called the mini pill), things may be different. About 40% of women will still ovulate, so these women may notice menopausal symptoms, such as hot flushes, as their ovulation becomes erratic during their menopause transition even while on the pill. In addition, they may be more likely to develop the typical irregular bleeding during their menopause transition (the pill with estrogen often treats this irregular bleeding, so it never happens). Basically, there may be menopause clues on the mini pill.

No period for several months after stopping the pill at the age of 50 means a person is almost certainly in either their late menopause transition (meaning close to their final period), or already postmenopausal (over the crimson bridge). It doesn’t matter if someone is postmenopausal or in the menopause transition, we treat symptoms regardless of location on the menopause continuum. As an aside, many people have their worst symptoms before their final period. 

Some of the symptoms described here are classic—joint pains, feeling hot, and generally feeling unwell. Some women do describe palpitations during the menopause continuum and hot flushes can be accompanied by anxiety, which can make your heart feel like it is racing. The reasons for these heart symptoms isn’t known, but one hypothesis is miscommunication within the autonomic nervous system triggered by the hormonal changes. Anyone with palpitations, or who is feeling their heart is racing, should have that symptom evaluated by their provider to make sure there isn’t another cause, such as a thyroid condition or a heart condition. While it’s true many women have their symptoms of menopause dismissed, it is also true that some women are told every symptom they are experiencing is menopause, but that is not always the case. Heart or cardiac symptoms should always be investigated. 

Someone who stopped the pill at age 50 may have worse symptoms as the pill has relatively high levels of estrogen. So instead of the meandering drop in estrogen over the many years of the menopause transition, there is an abrupt drop. There is also an abrupt rise in the hormone follicle stimulating hormone (FSH), which may also be involved with symptoms. One upside with the birth control pill is you miss the hormonal chaos of the menopause transition, one downside is when menopause hits, it may hit hard. Basically, some women may feel as if they are crashing into menopause.

If there are no contraindications and no active heart disease, starting menopausal hormone therapy (MHT) is a excellent option for someone who is suffering. This offers a way to step down estrogen levels more gradually. The benefits and risks are too much to discuss in this post (it is a large part of my book, The Menopause Manifesto). However, the short term risks (3-4 years) of transdermal estrogen and oral progesterone are incredibly low and anyone unsure of what they want to do long-term can try this form of MHT for several months or even a few years to alleviate symptoms, giving then time to decide. MHT typically helps with hot flushes, joint pains, and feeling unwell. 

Other options for hot flushes that have been shown to be effective are cognitive behavioral therapy, a couple of over the counter supplements (S-equol and relizen, a flower pollen extract, the data for both of these is limited, but they appear safe), certain antidepressants, and the medication, gabapentin.

Remember, none of these therapies—including hormones— are a tattoo, if you start one and you find them ineffective or they have side effects they can always be stopped. It can easily take 6 weeks to see an improvement in symptoms with most therapies, so that is something to keep in mind.