This week, I was gifted a copy of a popular new menopause book (one of dozens that’s been published in the last year).

I started flipping and skimming pages and landed on a passage that said: (I’m paraphrasing)

“The oral contraceptive pill (aka the birth control pill) can be used as HT. It’s a higher dose of estrogen than other forms of HT, and it can be especially useful in perimenopause because it brings a period of chaos into stability.”

Sounds appealing right?

We could all use a little less chaos in midlife - I know I could.

I had to stop myself from throwing the book across the room.

I’ll get into the science behind birth control, and why I think it’s an abhorrent form of hormone therapy for women in midlife in a moment.

But first, I’m going to spend some time explaining my objections to the current menopause movement.

Menopause Right Now

I don’t aim to live in a call-out culture or to be divisive, but—just like when I was a midwife and felt it was my responsibility to properly educate women on their birthing choices, free from fear—I feel compelled to tell you: there’s more to the story.

There’s more for you than medications to suppress symptoms.

There’s more than weighted vests and Creatine.

I am thrilled that menopause and healthy aging for women are getting attention. It’s necessary. And it’s personal.

I remember asking my mom several years ago how menopause was for her. Her answer?

“I didn’t have any symptoms.”

Yet, her mental health declined, she leaned on alcohol to self-medicate, and she developed breast cancer after age 50.

Her blood sugars climbed. She lost muscle mass.

My mom was an original feminist - she kept her name when she got married in 1979 and taught me at a young age about reproductive rights.

But no one taught her that menopause tanks serotonin and worsens mental health issues.

No one taught her that her pelvic floor issues might have improved with vaginal estrogen.

For my mother and all the women like her, I am so happy that Oprah, Naomi, Halle, and Mary Claire are talking about menopause. The message has been needed for so long.

And yet - at the same time that we’re shining attention on the numerous organ systems that fall apart with the decline of ovarian function (brain, muscles, bones, cardiovascular, skin, and more) - current menopause guidelines are still based almost entirely on a symptom-suppression approach.

The ONLY prevention strategy that HRT is recommended for by “expert organizations” is osteoporosis.

Let’s back up and discuss what optimal hormonal physiology looks like:

When we are in our prime reproductive years, the ovarian hormones estrogen and progesterone repeat a delicate dance, month after month.

Your period begins on day one.

Estrogen begins to rise five days later.

It peaks around day 12.

Estrogen’s peak triggers the release of LH from the brain (what an ovulation predictor test is looking for).

LH triggers the release of a follicle (egg).

The ovaries begin secreting progesterone on day fourteen.

Estrogen peaks again, with progesterone, on day 21.

Both hormones fall from day 21-28.

The decline of hormones triggers the release of the uterine lining, and bleeding begins again.

The Follicular Phase:

The first half of the cycle is about new growth — blood vessels grow in the lining of the uterus, and the lining of blood vessels throughout the body turnover, initiating repair.

Stem cell production is stimulated.

Repair is initiated.

New immune cells are made.

Bone regenerates.

Collagen is synthesized.

Nitric oxide is made, supporting blood vessel and tissue health.

Synaptic connections in the brain increase.

In the second half of the cycle, under the influence of progesterone + estrogen (the luteal phase):

Tumor-suppressor pathways, via p-53, initiate apoptosis — the process by which we initiate cell death in cancer-susceptible cells.

Myelin is repaired in the brain (the sheath surrounding nerve cells).

Systemic inflammation quiets.

Metabolically, fat becomes a better fuel source.

These processes are forgotten in the symptom-management approach to menopause.

How to take a physiologic approach to perimenopause and menopause.

Perimenopause can begin 10-15 years before loss of the menstrual cycle occurs. Yes! Really.

As ovaries age and go through a process known as senescence - when cells die and no longer continue to grow and perform functional duties, perimenopause sets in.

Ovarian senescence does not happen overnight. Rather, as ovarian function declines, women begin to feel the impact of lower levels and their more disorganized rhythms.

The process is inevitable, but it can be slowed down.

How can you optimize health in perimenopause?

Senescence is accelerated by oxidative stress and inflammation.

In my clinical practice, Aurelia Health, we work in early perimenopause to optimize ovulation with a whole-body approach.

This includes using food and lifestyle to lower inflammation, and supplements to ensure a woman has appropriate nutrients (like vitamins C and B and fish oil - all of which are great for the ovaries).

I love having women utilize a daily home hormone monitor like the Mira monitor in perimenopause - this allows us to decipher if she’s getting an appropriate estradiol peak prior to ovulation if she’s ovulating appropriately, and to assess her progesterone sufficiency.

When needed, we often employ herbs like vitex or others that can help optimize communication between the brain and ovaries and improve hormone secretion.

If someone is further into perimenopause, we employ customized hormone replacement therapy, either with a progesterone-only approach (always cycled on for two weeks and off for two, ideally).

Research suggests two things with regards to management of hormones in perimenopause:

Annovulation is not good for women’s health. When ovulation isn’t happening with regularity, or when progesterone secretion is low - there are consequences. Women who have ovulatory dysfunction earlier in life (like with PCOS or primary ovarian insufficiency) are more likely to develop cardiovascular disease, osteoporosis and diabetes.
The earlier you begin hormone replacement therapy, the better. Ideally intervention occurs before menopause occurs. Remember, systemic health is unraveling early on in hormone decline - it’s important to treat this like any other imbalance or insufficiency in the body.

Why birth control is not the solution:

Birth control contains synthetic hormones, typically ethynil estradiol (although there is one birth control type called Natazia that contains estradiol valerate), and a synthetic progestin such as norgestimate, drospirenone, or desogestrel.

Ethinyl estradiol does not confer the same benefits as bio-identical estradiol. It is not heart-protective, it does not protect the brain.

It may help you feel better because it shuts down hormonal secretion by the ovaries. This means that hormones that had wild fluctuations can become quiet and “stable.”

But do not be fooled into thinking that that’s a good thing.

A typical serum estradiol level for a woman on oral contraceptive pills can be as low as 20-30. That’s as low as a nearly post-menopausal woman.

That means bones, brains, and hearts are not protected.

In addition to not conferring benefits, birth control has real consequences.

It depletes B vitamins, increases intestinal permeability, and can disrupt thyroid hormones.

Other side effects include:

Breakthrough bleeding
Nausea
Breast tenderness
Headaches
Mood changes
Weight gain
Decreased libido
Vaginal dryness

There are also serious adverse effects:

Blood clot risk increases from 2 per 10,000 women per year in non-birth-control-users to between 8 and 15 per 10,000 in users.
Elevated blood pressure
24% increased risk of developing breast cancer.
Taking oral contraceptives for 5–9 years increases cervical cancer risk by 60%, and 10+ years doubles the risk.
The first two years of use are linked to a 71% higher rate of depression compared to non-users.

To call birth control hormone therapy is a fallacy, and it’s also lazy medicine.

The truth is, you deserve better.

Better than outdated protocols, quick fixes, and symptoms-only-suppressing solutions disguised as care.

Calling birth control “hormone therapy” is not only misleading—it robs you of the opportunity to support and protect your health.

Supporting hormone health in perimenopause needs to be about more than silencing symptoms—it should be about restoring rhythm, protecting vital systems, and honoring the full scope of midlife wellness.

Once ovulation on your own is no longer possible, targeted and personalized hormone therapy that optimizes hormone levels (and ideally rhythm too) is the best approach.

You are not meant to be managed. You are meant to be supported, with science and heart. Because real care doesn’t flatten your function—it helps you protect your health, for a lifetime.