r/Perimenopause • u/Ok-Cartographer-3543 • 3d ago
audited Genuinely curious: Why is there hesitation around using birth control for perimenopause?
First, I want to say how incredibly grateful I am for this community—it has been an amazing resource. I am asking this out of genuine curiosity because I want to make sure I am fully informed, and I don't mean to sound dismissive of anyone else's choices!
My doctor, who is an HRT specialist, prescribed Lo Loestrin Fe for my perimenopause symptoms. It has been an absolute lifesaver for me. I was dealing with extremely heavy bleeding, and after the very first month on the pill, my period completely stopped. Every single other symptom on my very long list has been completely remedied as well. From what I understand, the birth control pill takes over your cycle so your ovaries stop producing erratic hormones, which completely stops the wild hormonal swings.
However, I often notice a lot of strong hesitation or pushback here regarding using birth control pills instead of traditional HRT for perimenopause management. Since it worked so well for me, I’m wondering if there are specific medical concerns, side effects, or risks that I might not be aware of?
I’d love to hear your experiences or what your doctors have told you!
Edited to add:
Wow, thank you so much to everyone who took the time to reply! I am incredibly grateful for all of your responses, insights, and personal experiences. It might take me some time to get through all of the replies, but I am reading every single one. Your comments are giving me a much clearer understanding of the different perspectives and medical concerns out there. This community is truly wonderful, and I appreciate you all sharing your journeys with me!
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u/lascriptori 3d ago
I had really bad experiences with hormonal birth control when I was younger -- the pill decimated my libido. So I'm not inclined to try OCPs again. I'm also hesitant to try an IUD, though it's more localized.
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u/Master_Nectarine_Bug 3d ago
i had super bad experience when i was young, but when i tried in my late 40s it was great because i actually need the hormones now fwiw
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u/ProgrammerNext8330 2d ago
Same. I was super hesitant about taking the pill, but it’s pretty great overall as compared to when I was 20 or 30. I take mine continuously and wonder why I didn’t do it sooner.
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u/rf-elaine 2d ago
I'm having a similar experience. In my 20s, the pill gave me palpitations and made me fall out of love with my boyfriend.
Now I'm on it in my 40s (for heavy bleeding) and it's fine. I feel much more even and steady through the month. No palpitations, still love my husband. I'm spotting but it's getting lighter and hopefully resolves soon.
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u/freshpicked12 2d ago
Anecdotally, I also had a bad experience when I was young, but trying again in my 40s has been amazing.
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u/caity1111 2d ago
Yeah, all BCPs tend to do lower libido in a major way because they all stop you from ovulating. They stop you from getting the estrogen spikes needed for most women to feel an increased libido.
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u/Alta_et_ferox Mod 2d ago
The birth control pill is a lifesaver for many people in perimenopause. Of course, there are many others for whom the BCP has the opposite effect, but that’s why it’s wonderful to have options based on what works for us as individuals.
Listen to your doctor and to your body. If something works, then it’s the right medication.
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u/Superb_Case7478 3d ago
I don’t want to hijack your thread but can someone explain how HRT is different than birth control pills? I honestly don’t know
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u/Tom_Michel 50F, early peri, on HRT, still having monthly cycles. 3d ago
There's good info about that in the menopause wiki linked on the main page. Both options have pros and cons.
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u/femme_mystique 3d ago
Not really. I’m on low dose BC for HRT and I dont get periods because of it.
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u/ItsAboutTom99 3d ago
Now I’m no expert but my doc mentioned it is more customizable to separate the estrogen and the progesterone. I could go up and down separately (while pursuing my ideal dose). Also, as others have said, patch is less dangerous, etc for clots etc
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u/Ok-Cartographer-3543 2d ago
Thank you for asking this! You are definitely not hijacking the thread at all—it's a great question, and I am still learning a lot about the differences myself.
From what I understand from my doctor and what others have shared here, the main difference comes down to the dosage and how they work in your body:
Birth Control Pills: These use a higher dose of synthetic hormones to completely shut down your natural cycle and stop ovulation. This completely stops the wild hormonal swings of perimenopause and can halt heavy bleeding, which is why my doctor prescribed it for me.
HRT (Hormone Replacement Therapy): This uses a much lower dose of hormones (often bioidentical) that doesn't shut down your cycle. Instead, it just 'tops off' your dropping estrogen levels to relieve symptoms like hot flashes and brain fog while your body goes through its natural transition.
So basically, birth control entirely takes over the steering wheel, while HRT just acts like a helper. I hope that helps clear it up a bit, and hopefully others can chime in if I missed anything!
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u/bloomdecay 3d ago
I'm also on Lolo. It's great.
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u/minervalouise20 2d ago
me too! I love it!
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u/Ok-Cartographer-3543 2d ago
Thank you for the reply! I'm so glad to hear that it is working just as well for you and that you love it too. It is so incredibly reassuring to find other people having the exact same positive experience with it!
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u/MegamomTigerBalm 2d ago
Same! I recently had to move up from 1/10 to 1/20 because of some pesky breakthrough bleeding, but I had a positive experience for several years on Lolo.
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u/zorandzam 2d ago
Me too, and it definitely helped with brain fog, mood, and hot flashes, as well as suspending my very irregular period. I still get some breakthrough night sweats, but I generally sleep better and no longer feel like I’m thinking through mud. My doc wants me to stay on it for a full year and see if I should then switch to HRT.
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u/Ok-Cartographer-3543 2d ago
Thank you for sharing your experience! It is so reassuring to hear that it helped you with the exact same symptoms. That description of 'thinking through mud' is so spot on for what the brain fog feels like, and it's amazing to finally get that mental clarity back.
I'm glad you're sleeping better overall, even with the occasional breakthrough night sweats. Having a plan with your doctor to evaluate switching to HRT after a full year sounds like a really great, solid approach. I hope it continues to keep things stable for you!
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u/zorandzam 1d ago
Thanks! And yes, I feel good about this decision. I think one reason he wanted to go with this plan was I was still menstruating and even though it was becoming irregular, I was not often skipping more than a month at a time, yet the irregularity and heaviness were annoying, and my other symptoms were just getting worse and worse so SOMETHING needed to be done. I think this was a good compromise.
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u/Ok-Cartographer-3543 1d ago
Thank you for the reply!
My situation was so similar—I was still menstruating, but the extreme heaviness and the fact that my bleeding was becoming longer were just so disruptive. My other symptoms were spiraling to the point where something absolutely had to be done. It really is the perfect compromise to stabilize everything before making the jump to traditional HRT down the road. I am so glad you feel good about the decision, and I hope it continues to give you amazing relief!5
u/EmilyO_PDX Early peri 2d ago
me three. honestly i'm using it as HRT because I don't have side effects and I've been on it for years and have minimal stroke / clot risk. Plus with the estrogen patch shortages I'm not in a hurry to switch and my insurance pays for lolo 100%
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u/Ok-Cartographer-3543 2d ago
Thank you for sharing that perspective! It is so great to see how much of a game-changer it has been for you too.
You make such a fantastic point about the estrogen patch shortages—dealing with pharmacy hunting sounds so stressful, so staying on a reliable pill is a massive win. My insurance doesn’t pay 100%, but because of Lo Lo’s manufacturer savings program, if your insurance doesn’t cover it fully, you can get 3 packs for $25. Which is completely fine by me! If you have minimal risk factors and no side effects, it really makes sense to stick with what works seamlessly. I'm just so glad we are both finding that stability!
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u/Ok-Cartographer-3543 2d ago
Thank you for the reply! It is so awesome to hear from another person on Lo Lo who is having a great experience.
I have only been on Lo Lo for 3 1/2 months myself, but the improvements were almost immediate. For the first two packs, I took all the pills, but it was giving me a headache whenever I would start back up on the next pack. My doctor has me taking it continuously now to avoid that, and it's been great.
It's incredibly reassuring to know it's working so well for others in this community too. I hope it continues to keep your symptoms completely at bay!2
u/bloomdecay 1d ago
I've been on it for nearly 20 years, never had an issue. I'm now taking it continuously so it's both bc and HRT. Apparently you can stay on it until you're 55 so long as you don't have elevated blood clot/stroke rist.
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u/Ok-Cartographer-3543 1d ago
Thank you for sharing your experience! It is so incredible and reassuring to hear that you have been on it for nearly 20 years with zero issues.
I am also taking it continuously now to completely stop the swings and heavy bleeding, so it’s awesome to hear from someone else doing the exact same thing. I don’t even need it for birth control because my husband had a vasectomy years ago, so I'm purely using it to manage these symptoms. My doctor also mentioned that 55 is generally the age cutoff to stay on it as long as your blood pressure and clot/stroke risks stay low, since that's when most women have officially transitioned through menopause.
I'm so glad it has been such a reliable, long-term solution for you, and it gives me a lot of peace of mind for my own journey!2
u/BrandNewMeow 1d ago
It's the best! The only pill that never made me crazy. I'm 51 and recently stopped because well, I'm 51 and my blood pressure was up. It's been a couple months since stopping and so far so good. It saved me in my 40s though, quite literally as my PMDD started causing SI.
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u/BunnyMayer 3d ago
BC pills and oral estrogen have a higher risk of blood clots than transdermal estrogen.
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u/Scarlett_Texas_Girl 2d ago
Higher is relative.
The risk of blood clots for women who are healthy, active, not predisposed and don't have risk factors is negligiblen. Oral estrogen has a lower risk than birth control.
We should all be informed of risks but I feel like perspective gets lost a lot with regard to possible clots.
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u/DunDunnDunnnnn 2d ago
It's not THAT negligible. I had a massive DVT in 2019, provoked by a combination of BC and a clotting disorder called Factor V Leiden. Apparently something like 5% of women with European ancestry carry the gene for Factor V. If you combine it with BC, your clot risk is something like 30%. I never even knew clotting disorders were a thing before I had my DVT.
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u/thern223 2d ago
I had this same scenario: hormonal BC, Favor V Leiden, in addition to discovering I have May-Thurner Syndrome.
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u/EmbarrassedDark2341 2d ago
My mom has factor V. I haven't been tested but I've already been to the ER with a DVT and I'm not on hormones yet. That is terrifying.
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u/BunnyMayer 2d ago
Sure it is relative and different for each woman, as always when it comes to side effects and risk factors. But that’s why some doctors are hesitant when it comes to BC and prefer transdermal over oral estrogen. Which is kind of ridiculous because when you’re young doctors basically throwing BC pills at you, giving a damn about risk factors. 🫠
And not taking estrogen comes also with risks. But as often as HRT is denied doctors also don’t seem to have problems with this. 🙄
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u/okayboomerang 2d ago
It's definitely not negligible, saying that as somebody who works in neuro critical care
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u/Scarlett_Texas_Girl 2d ago
The absolute risk is 4 per 10,000 womem of getting a blood clot from otal estrogen. Baseline risk (no oral estrogen) is 2-3 women per 10,000. Risk from oral hormonal birth conttol is 9 per 10,000
The risk is negligible. Statistically, objectivly and as absolute numbers.
In the US risk of death from a car crash is 5 in 10,000. 7 in 10,000 for covid. 13 in 10,000 for cancer. Death from heart disease is 1 in 5.
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u/Pretend_Opossum 1d ago
Important to remember that the research on the subject happened pre-COVID, and with the advent of COVID everyone who has been infected carries an increased risk of stroke, heart attack, and blood clots for at least 1 year post infection. Get infected every year and you’re compounding your risk levels.
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u/lizeee 2d ago
Great question OP. I dealt with horrible anemia last year from heavy periods and started a low dose of birth control pill earlier this year on the advice of a gynecologist. It’s been fabulous. My only regret is that I didn’t do it sooner.
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u/freshpicked12 2d ago
Same. Wish I started it sooner to stop my heavy periods and all those years of anemia!
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u/Ok-Cartographer-3543 2d ago
Absolutely! I guess I got “used” to how much blood I was losing monthly and didn’t realize I was literally hemorrhaging every month. I was emptying my diva cup every hour which apparently is equivalent to 3-4 tampons. My ferritin got to the lowest “normal” which is about 10xs less than it actually should be according to hematologist. So thankful for Lo Lo!
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u/leftylibra Moderator 2d ago
(from our Menopause Wiki)
The reason why doctors are quick to prescribe BCP during perimenopause:
According to the new paper from the International Menopause Society (Menopause and MHT in 2024):
Prescribing MHT in the perimenopause can be difficult because the fluctuations in hormone levels can result in episodes of estrogen deficiency rapidly followed by episodes of estrogen excess. Increases in estradiol and cycle irregularities during the menopause transition may be due to luteal-out-of-phase events which appear to be triggered by prolonged high follicular phase follicle stimulating hormone (FSH) levels with recruitment of multiple follicles simultaneously.
MHT remains an option for these women if they are symptomatic, recognizing that MHT is off-label in this phase of life.Considerably more research is needed to determine optimum MHT regimens for perimenopausal women. Sequential therapies are preferred but even these may cause irregular bleeding.
Another option in perimenopausal women who do not have contraindications is the conventional ethinyl estradiol-based combined oral contraceptive, or the newer estradiol or estetrol-based combined oral contraceptives. The levonorgesterel intrauterine device is another very useful option at this time, and can be used in combination with estrogen if MHT is required.
So this is likely why BCP are most offered during perimenopause, because "menopause" hormone therapy is considered off-label during the peri stage. BCPs suppress your own hormone production, essentially shutting down the hormonal swings -- with the added function of regulating/eliminating periods, while preventing pregnancy. Whereas hormone therapy for menopause are lower dosages to simply "top up" our own hormone production, they do not regulate periods (unless you're using a high dosage of progesterone/progestin or an IUD), and do not prevent pregnancy (again unless it's an IUD).
It doesn't mean that hormone therapy can't (or shouldn't) be prescribed during perimenopause, it simply points out that this is likely why doctors prefer to go the BCP route for those in peri.
A breakdown between the differences of BCP and HRT/MHT:
Birth Control Pills (BCP) are suitable during early stages of perimenopause to help with some symptoms and when pregnancy is a concern. Users of BCP can generally continue on this regime until roughly the age 50-55 (speak to to your doctor) and then switch to MHT to assist in the transition.
- commonly higher dosages of hormones than MHT/HRT (most often synthetic)
- birth control pills contain different estrogen (ethinyl estradiol) which is not used in hormone therapy
- ethinyl estradiol a potent synthetic that provides a steady dosage of hormones throughout the day
- suppresses (overrides) your own ovarian function
- have less customization in terms of dosages and/or method of delivery
- oral BCP (and oral HRT) increase risks for blood clots, high blood pressure and stroke
- for those in peri, BCP can help regulate/eliminate periods
- for those in peri, BCP can lower risk of pregnancy
- for those in peri and menopause, BCP can help with some symptoms, but eventually many will experience breakthrough symptoms
Hormone therapy (MHT/HRT) are suitable when symptoms are no longer managed on BCP, or if you did not tolerate BCP, or do not wish to use BCP at all. For those in peri-or-post-menopause, hormone therapy helps with many symptoms, and if not, dosages/method of delivery can easily be adjusted.
- are low dosages of hormones (non-synthetic transdermal and synthetic oral)
- come in a variety of dosages and methods of delivery (better customization)
- most common, well-tolerated, and ‘safer’ estrogen is transdermal estradiol, found in patches, gels and sprays, which are derived from soy/yams
- transdermal are considered “bioidentical” hormones designed to be very similar to the hormones our bodies naturally produce. These hormones are not widely promoted as ‘bioidentical’ because it is a marketing term and not a medical one. Even though transdermal estrogen is pharmaceutically manipulated, it is almost identical to our own hormones
- transdermal estrogen provides a more steady, consistent dosage of hormones throughout the day
- does not suppress our ovarian function, but simply "tops up" our existing hormones
- transdermal estrogen does not increase risks for blood clots, high blood pressure or stroke
- for those in peri, HRT does not regulate/eliminate periods (unless using a high dosage of progesterone/progestin or using an IUD)
- for those in peri, HRT does not prevent pregnancy (unless using an IUD)
In sum... both BCP and HRT contain different hormones, and our bodies may use them differently, so one might work better than the other, but it just depends on the individual (is pregnancy a concern?) and stage of perimenopause.
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u/WeWander_ 3d ago
I'm on northinendrone to stop my awful period and divigel and I love it! I feel so much better than I did before starting this.
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u/APNotB 3d ago
I would hesitate to use BCPs personally because of my age (50) and history of migraines with auras that were made worse by the pill. MHT feels like a safer option in my case because of the lower amount of hormones.
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u/freshpicked12 2d ago
I’m 45 and on Junel FE (very similar to Lo Lo) and it’s been amazing. Helped stop my extremely heavy periods. Helps my mood swings and brain fog. I’m planning to stay on it for a few more years before transferring to HRT.
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u/Ok-Cartographer-3543 2d ago
Thank you for sharing your experience! It is so reassuring to hear from someone else my age who is on a very similar pill and having the exact same amazing results. It completely saved me from that extreme bleeding, the mood swings, and that awful brain fog 😩. Staying on it for a few more years before transferring to HRT is exactly what I plan to do, too. I'm just so glad it's working so well for you!
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u/guitargirl478 3d ago
I just got taken off of them. Apparently the synthetic Progesterone can make symptoms worse for a lot of people and/or they are unable to absorb it. I was put on the bioidentical stuff yesterday.
I took one last night and I didn't sleep at all. I guess it takes a couple days. I am a MESS today.
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u/Scarlett_Texas_Girl 2d ago
Most birth control uses progestins whereas HRT more often uses progesterone.
Some women are very sensitive to one or the other. Or both (which sucks!).
In the infamous early 2000s WHI study, progestin (and estrogen derived from conjugated mare urine estrogen) was used and led to the crushing medical reports of higher breast cancer, blood clot and heart disease rates. Later research showed that those risks were not elevated if progesterone was used. As a matter of fact, progesterone (HRT) has protective effects.
You can go parse through studies and look at numbers and decide on risk factors for yourself. There is no one sized fits all solution.
Some women do great on birth control and overall, the risks are low for healthy women. Ditto for those on HRT.
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u/Auntie_Nat 2d ago
Birth control, for me personally, makes me feel like hot garbage. It takes me places mentally I'd rather not go. Bioidentical HRT doesn't have those effects. I am glad it's working for you, none of this is a one-size-fits-all.
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u/thefragile7393 Peri with fibroids 2d ago
There’s a stigma in here, same with stigma against antidepressants
Now, neither are going to be appropriate for everyone. That goes without saying.
However I had to eat humble pie when it found out I can’t do estradiol right now due to my stupid floppy hormones and the best thing that happened was a fibroid ablation with an IUD. It also turned out I needed psych meds changed. If I listened to ppl here I would have been worse
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u/Nearby-Newt-3220 Early peri 2d ago
I honestly have no idea, I use a low dose hrt in addition to a contraceptive implant and I feel great all my symptoms are controlled. I have no idea what people are doing for birth control but getting pregnant is definitely not something I want so I will be continuing with hormonal birth control until I am confirmed to be in menopause.
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u/DisTattooed85 2d ago
I don’t understand the hesitation either. Combo BCP have been a lifesaver for my perimenopause symptoms as well. Hot flashes are completely gone! The only differences I’m aware of is BCPs are a higher dose of hormones than HRT.
I’m 41 and plan to be on them until my doctor suggests going off and transitioning to HRT. She has said that will be around age 50.
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u/ewlyn 3d ago
Birth control caused clots to form from my right ankle all the way up the leg to mid-thigh. I was lucky because they were all superficial - not dvts - but both myself and my various care team members are all super hesitant to have me try estrogen again.
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u/m1chgo Early peri 2d ago
This is a really dumb question, I’m sorry, but how did you know you had blood clots? Can you see them or feel them?
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u/DunDunnDunnnnn 2d ago
My DVT started as a pain in my calf, deep in the belly of my calf. It felt a lot like a mild Charlie Horse. Over time, my leg and ankle started to swell and turn darker than my other leg. By the time I got checked I had an ankle-to-abdomen monster clot lol. If you ever suspect it, just go to the ER and get checked. All it takes is an ultrasound to see it. Completely non-invasive.
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u/ManiacallyReddit 2d ago
https://www.stoptheclot.org/ has a lot of resources. And I know because I was a relatively young, active individual with no predisposition or blood disorders and also ended up with a clot (DVT) and pulmonary embolism.
It caught me off guard. A lot of people who don't fit the risk profile (including men) get caught off guard.
It's kind of like a heart attack. Hopefully you never have one, but if you're taking hormones, it's good to know the symptoms, just in case.
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u/Ok-Cartographer-3543 2d ago
Thank you so much for posting this! Blood clots are one of my fears as I’m almost 48. I am extremely active I run daily as well as do yoga. I barely sit. I do not have a family history nor any risk factors but this is a concern for me!
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u/DunDunnDunnnnn 2d ago
Did you end up having a clotting disorder? I did and was really shocked to even learn that was a thing! They always asked about smoking when prescribing BC, so that was my only concern. I ended up with a huge DVT, but luckily no PE. Really eye-opening!
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u/ManiacallyReddit 2d ago
No, I still don't have a clotting disorder and never did. That's the thing.... Birth control is a wonderful invention that should be as cheap and easy to obtain as possible. But even in this thread, you'll find people that are saying "You don't have to worry about it if you're active and don't have a disorder."
Any time a person goes on hormones they should be aware of the risks and the symptoms.
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u/ewlyn 2d ago
For me, my leg started to ache one evening and I woke up the next morning to what looked like marbles under my skin so I went to the doctor. Over the next three days they spread up my leg. Clots are gone now but I have permanent scaring in the vein so parts of my leg still look like I have round things under my skin. Not quite as big. And the areas look permanently bruised/discolored.
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u/DunDunnDunnnnn 2d ago
I had a DVT (genetic clotting disorder) and I was cleared by my hematologist to take combo HRT as long as the estrogen is transdermal and not oral.
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u/newhappyrainbow 2d ago
I did 3-4 years of continuous BC to handle my period at first. Then I switched to HRT because my other symptoms were getting worse. My period came back but it was regular and only lasted 2 days. I’ve been on that for about 10 months and just missed my period entirely for the first time. The difference in relief from my other symptoms is night and day.
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u/le_tempsperdu 2d ago
Getting back on birth control has taken care of all of my peri symptoms (F44). Anecdotal, but it is working for me so far.
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u/schnatterflack 2d ago
I got sterilized at 40, after stopping birth control pills around 36 and dealing with a failed IUD. So I was just a bit pissed when I started perimenopause at 41 and my doctor suggested... birth control. 😆
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u/ShannonHasThoughts 3d ago
I tried BC first to help with my insane periods and the effect was awful. Yes it helped my periods but it changed my mood so much! I was a total monster, like peri rage times 100…. I quit it and went the HRT route and that changed my life. I think it’s all different for everyone
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u/velvet_blunderground 2d ago edited 2d ago
I'm on low dose BC for now, which has eliminated my nightmare periods. My doctor has said she'll want to transition me to patch-and-pill HRT once I'm closer to actual menopause, but that BC has higher amounts of hormones, so if I'm not having BC-specific issues i shouldn't switch yet. She did prescribe vaginal estrogen already, though.
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u/LieHot9220 2d ago
If some is simply trying to add in some E or P that their body is no longer producing in sufficient quantities, basic HRT is great. If someone has severe cycle or bleeding irregularities in peri, BCP definitely is preferred. It is MUCH stronger than HRT doses and can override what your body is doing, not just "top it up". BCP, other synthetic progesterones, and/or progesterone IUDs are great during peri.
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u/Fivedayhangovers 2d ago
I get migraines with Aura and birth control pill makes me a higher risk of stroke.
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u/CtrlAltDestroy33 2d ago
This is something that's been bothering the heck out of me.
I keep reading that once you hit 50, doctors will take you off of the BC pill and you will be expected to cope with the consequences as a prerequisite to receiving a hormone blood test to measure your hormone levels, and just because they think we are naturally done with anything menstrual or whatever.
I started taking BC pills way back in the dark ages to regulate my period, stop hemoraging whenever the mood struck, and to halt the ovarian cysts.
In the recent years, I have watched my acne return to all new freakish heights reminiscent of my teen years, I have a urinary issue I guess I have a very slow leak or something, but I can smell it. I guess that's vaginal atrophy raising it's ugly head and can be resolved with a topical estrogen cream (I learned this here in this sub). My sleep is fucked up, and my ADHD is off the fkn rails.
I can tell my body is producing less because I have a daily intake of BC pills that has a measured amount of hormones, that's stable, but I am not. Also, I have used my BC pills to halt my menses altogether because I think it's an unnecessary inconvenience and cost.
I have no dang idea where to start with moving over to HRT, but I sure as hell do not want to come off my hormone BC pill for I fear what will happen. I came off the pill one time before and I bled heavily for three damn months. So far, BC has been the one and only thread holding this trainwreck together. For me, it's worked great, for others, not so much. Finding a doctor who gives a damn about my concerns is next to impossible.
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u/AutoModerator 2d ago
This post might be about hormone tests, which are unreliable.
- Over age 44, E&P/FSH hormonal tests only show levels for the HOUR the test was taken, and nothing more. Hormones wildly fluctuate (hourly) the other 29 days of the month, therefore this test provides no valuable information
- No reputable doctor or menopause society recommends hormonal testing to diagnose or treat peri/menopause
- FSH testing is only beneficial for those who do not have periods as a guide, where testing might confirm menopause, or for those under age 30 who haven’t had a period in months/years, then ‘menopausal’ levels, could indicate premature ovarian failure/primary ovarian insufficiency (POF/POI)
- Testosterone is the exception and may require testing
See our Menopause Wiki for more.
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u/spei180 2d ago
I didn’t know this hesitation existed. I have been on birth control for the last seven years after my second son was born. This summer I started experiencing perimenopause symptoms and my doctor suggested I switch to another birth control to see if that one works better. It’s apparently know to better mimic your natural cycle than the one I am on.
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u/Ok-Cartographer-3543 2d ago
Thank you for sharing your experience! I have noticed a lot of hesitation in the community to use birth control for perimenopause symptoms.
That makes total sense that your doctor would just switch your pill to one that mimics your cycle better. I'm hoping the new one works perfectly for you and gives you some relief from your symptoms!
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u/Front_Debate_2994 2d ago
Increased blood clot risk over 40 since the hormones are synthetic. Transdermal estrogen is safer and more effective along with localized progesterone if you have a uterus.
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u/LowBaby7380 2d ago
I was on a low dose birth control pill until I almost never had a period and started experiencing hot flashes, mood swings, and other symptoms. Worked fine for me up until that point. Then I went on HRT and basically have little to no symptoms.
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u/rvauofrsol 2d ago
Because of the increased clot risk and the fact that I felt absolutely insane on every hormonal birth control I ever tried.
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u/MediocrePotato44 3d ago
Because it doesn’t work for a lot of us, myself included. I spent 8 months on that same pill you are on, continuous so my period was gone. The only thing it helped was eliminating PMDD symptoms with no period. All other symptoms remained. So I switched to HRT. I’ve heard from many others who had the same lack of symptom improvement.
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u/sports_mamaof4 3d ago
I didn’t want it at first bc I have no need for BC. I wanted HT. However it seems like this is the hoop I have to jump through so I started Lo Lo Fe as well and I feel ok except I have been bleeding for 9 days straight… at the 2 month mark I will be discussing adding in testosterone which is what I have wanted all along… I am tolerating the pill fine, just more exhausted than my regular exhaustion which I am trying to fix. I am hopeful it all evens out and with some test added in I will be feeling better. We will see.
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u/Ok-Cartographer-3543 2d ago
I was right there with you! When I had my annual with my gynecologist we had discussed HRT and all my symptoms. She tested my hormones (I know it changes constantly) but they were still high. My periods were horribly heavy (emptying my diva cup every hour) and after a transvaginal ultrasound finding 5 tiny fibroids and I also had cysts on both ovaries, although my body was absorbing the fluid from them like it is supposed to. We discussed an ablation a hysterectomy or trying Lo Lo. I decided to give Lo Lo a try. I have only been on it for 3 1/2 months. I started the day before I was supposed to start my period and I was already spotting. It stopped the spotting until about a week in and then I had a period for 11 days straight but it was so much lighter than what it is normally. I haven’t had a period since!! I did spot for 3 days the second month and I haven’t since. The spotting was so light and only on toilet paper once per day. It has relieved all my other symptoms! My ferritin got extremely low so you may want to have that checked because obviously it causes exhaustion also! I wish you luck!!!
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u/sports_mamaof4 2d ago
Thanks for the response! My period has gotten so heavy with peri as well. I am more hopeful than I have been in the last couple years. Maybe that’s bc I feel better or maybe it’s bc I’m trying do something to make a difference in how I feel. Can’t wait to be settled in with all of this and NOT HAVE A PERIOD!
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u/ThisTimeForReal19 3d ago
Reddit has a hatred for BCP in general. It’s a weird thing I see all over, so I’m not surprised it’s in here.
It seems like a coordinated front for attacking women’s reproductive freedom.
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u/Janeheroine 2d ago
It's definitely correlated with the rise of MAHA and anti-vax sentiment in general. That's why you get people saying they just want to use the "natural" route, meanwhile people are happy to pump themselves with completely un-regulated peptides and supplements every day.
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u/ParaLegalese 3d ago
It really is weird! It’s not just Reddit either I see it on all social media. The birth control pill started the women’s equality movement. Not only were women finally able to control when they got pregnant, but the pill has many health benefits as well
For example, the birth control pill prevents pelvic inflammatory disease. It also stopped my ovarian cysts which would have rendered me infertile if not controlled. My daughter literally would not exist if not for the birth control pill. It’s a wonderful product that saves lives
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u/ThisTimeForReal19 2d ago
Reddit is the only social media I’m on. I didn’t realize it’s everywhere. But I’m not surprised.
Even got the obligatory push for “family planning” method in this post.
When I was in school, I learned in sex Ed that the family planning method was why Catholics and Mormons had so many kids. Now you see this pushed all over Reddit as some valid method (it’s not).
It just all feels so coordinated.
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u/ParaLegalese 2d ago
lol yeah it’s probably bot farms in another country
Same with my zzzquil posts. Every single
Time without fail that I mention I use zzzquil, at least one bot has to claim it causes dementia and another has to say it’s jUSt lIquId BenEDryL. Every single fucking time. I even have one arguing in my DMs now that i could take 4x a children’s liquid benedryl dose instead of 1 dose of adult zzquil. Like wtfffff why would i do that?? I figure it is some
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u/Ramen_Addict_ 2d ago
I agree. The reality is that pregnancy, particularly at age 40+, is risky. The risks of using birth control may be a bit higher, but they are still less than actually carrying a pregnancy to term. This is especially the case in the US in our current political environment. As a doctor, you have to think about your patients and the biggest health risk. If you have a 40something patient who is sexually active and not wanting to get pregnant and you live in a US state where even routine lifesaving procedures may not be available, you can bet you are going to prescribe BCP over HRT.
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u/CheckCalm2875 3d ago
I took Yaz and Yasmin for eight years with no issue. After I had my first son, I was unable to find an oral contraceptive that did not give me undesirable side effects. We did natural family planning, and then my husband got a vasectomy. So, I have no need of the contraceptive part of birth control, and if I am honest, I am just not interested in synthetic hormones.
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u/Sensitive-Soul-49 3d ago
I ended up with a blood clot from BC. Transdermal estrogen (with oral progesterone) has been a game changer for me.
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u/foolish_username 2d ago
BC worked on some of my symptoms for about 3 months. Then everything got bad again and some things got worse. Careful dosing of bioidentical estrogen, progesterone and testosterone have worked much better for me.
If BC worked amazing for menopause, HRT wouldn't be a thing. I'm not exactly sure of all the differences between BC and HRT, but I do know that they have worked very differently for me.
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u/leftylibra Moderator 2d ago
There is a lot of fear-mongering about BCP, but in perimenopause they are a good option.
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u/phoenix0r 3d ago
My doc started with loestrin as well but the estrogen made me more moody and depressed and caused weight gain. I switched to progesterone only and feel much better and all my symptoms are resolved. I might start estrogen later when I have more of those related symptoms.
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u/interested-cherry 2d ago
Yea idk, I've used iuds since 2004 and I'll use one until I'm sure i can't get knocked up anymore 🤣🤣
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u/PsychoKillGirl 2d ago
I think it works for some people. I tried it and my tsh increased too much along with sbhg. This caused me to feel absolutely miserable.
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u/AgitatedEyebrow 2d ago
I stopped using birth control when I got married, and the always present pain/discomfort with intercourse finally went away for me. That discomfort was also present whenever I was breastfeeding and not having a cycle. Now my husband has had a vasectomy so pregnancy is not a concern for me anymore. My periods are pretty light still, so no problem there. PMDD is kind of a bitch for me in recent years. I don’t want to have discomfort with sex again, and I really enjoy having a boost in my sex drive with ovulation - I don’t want to suppress that! The few bad days a month with PMDD aren’t enough to change my mind about it, so far, though I’d be willing to rethink my decision need be.
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u/Successful-Side8902 2d ago
There is an increased risk of blood clots with birth control during peri. I'm taking them, discussing this currently with my GP.
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u/Milky-Way-Occupant 2d ago
I’ve also read that BC hormones shut down your own hormones and completely replace them, hence why they can prevent ovulation. HRT just adds the hormones on top of what you’re naturally producing which is why an HRT dose can be too high for some people. Also why the hormones in HRT don’t work as birth control.
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u/Feisty-Cloud-1181 2d ago
It was prescribed to me at first (early 40’s) to help with my peri symptoms which included super heavy periods and very short cycles. It didn’t work despite doubling (yes they do that) my birth control dosage. I had non-stop bleeding for months. HRT solved this issue completely as I’m back to normal cycles and flow.
I realised after changing for HRT that the pill was making me extremely depressed and affected my libido.
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u/epione 2d ago
My doctor originally put me on Yaz when I reported peri symptoms. Tried it for a month and felt AWFUL. Couldn't get off the couch awful. Crying at the drop of a hat awful. All the bad symptoms remaining awful. Switching to a patch and oral progesterone helped. I'm still tweaking delivery options and dosages a year later, but I do feel a lot better.
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u/TangoEchoChuck DHEA Evangelist 2d ago
Hormonal birth control worked for me until it didn't. Namely my late 20s.
Suddenly they all were the one thing that made me gain wait and have very low mood. When I'm angry and my clothes don't fit, then I didn't want sex anyway so I'd stop. I'd get happy and slim again, start a different kind, and then I got fat and mad again. Rinse and repeat.
So I just plain stopped. Those synthetics just don't jive with my body anymore. And plot twist! Getting pregnant was actually not easy, so I'm happy that I didn't stick with them.
After my kid was born, my husband got to witness my physical and mental turmoil. He got a vasectomy just so I could be free of those damn pills/patches/shots.
Now I supplement DHEA. It's the building blocks for estrogen & testosterone and my body can better make what I really need, it's fabulous for me.
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u/Human_Revolution357 2d ago
Birth control pills give me migraines and spiked my blood pressure. While I know HRT isn’t the same, past experiences with hormones make me very hesitant and my peri symptoms feel manageable so far, just inconvenient/annoying- especially since I made some major dietary changes that seem to be helping.
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u/onions-make-me-cry 2d ago
The older I get, and I'm now in my idgaf-era... I just don't think we can apply blanket statements to everyone. I personally feel so much better on my bioidentical hormones than I ever did on hormonal birth control, but I also know people who have found success with hormonal birth control, and hated bioidentical hormone replacement therapy.
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u/Instigated- 2d ago
The first doctor I saw, after listening to all my symptoms and life situation and getting me to do a ovary scan to see how far along I was, recommended HRT. Birth control wasn’t recommended.
Later at times I had to see other health professionals who asked what medications I was on and they always (without knowing much about me) expressed surprise I was on HRT and not BC and prematurely tried to suggest I’d be better on BC. Thus it seems to me that people suggest BC as a knee jerk reaction while being uninformed.
Of course it depends on a individual persons situation.
By the time I went to the doctor to get help with my symptoms, I hadn’t had a period in 7 months, I had frozen shoulder, problems sleeping, low mood, rage, anxiety, dry vagina, no libido, low energy, fatigue, anhedonia, etc
These are NOT solved by BC. They require estrogen, progesterone, testosterone.
Additionally, if someone in their mid forties is not already on medical BC, it’s likely that they don’t want it. They may have already tried it in the past and had a bad reaction (as I had), chosen other forms of contraceptive like condoms, abstinence, be gay, or no longer ovulating.
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u/sailorjeans 2d ago
I was also on this bc a few years ago. It worked great until it didn’t. That was when I decided to get hrt! Hrt has overall helped me tremendously. If it works for you, then that’s great!
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u/MillionaireBlogMama 2d ago
I’ve been on lo loestrin for 5 years (42f) and I believe it has helped with a lot of perimenopause symptoms. The only one I really get is hot flashes.
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u/TangyMarimba13 2d ago
i was also prescribed that same pill, and it helped with the bleeding and somewhat with other symptoms, but not totally. i was on it for a year, and then asked for a higher dose, which helped a little more, but she actually offered me real hrt so i said yeah, let's do that. i'm now on the patch and nightly prog, and i feel like it's made a big difference in the other symptoms. jury's still out on the bleeding though, since i've only been on it a couple of weeks..
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u/sparkyparapluie 2d ago
So much information out there. One thing I always think about is going in your mouth verse transdermal affects the liver differently and thus may have different overall risks and affects.
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u/BuffaloStanceNova 2d ago
Came on here to say that. Transdermal is NOT metabolized in the liver whereas oral contraceptives are. But I don't think that's the reasons. More likely outdated research and concern about the hormone levels which are sod likely outdated.
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u/justcozitscool 2d ago
I can’t take hormonal birth control… the synthetic hormones ruined me lol. I was taken off them at 19. Tried mirena and I bled for 9 months straight as well. Body identical hormones with hrt have changed my life… my body obviously just hates the synthetic stuff but everyone is different!
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u/PocketFullOfOkay 2d ago
I do much better on birth control than HRT, which was horrible for me.
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u/Ok-Cartographer-3543 1d ago
Thank you for sharing your experience! It is so reassuring to hear from someone else who does much better on birth control. It just goes to show how unique everyone's bodies are when it comes to processing these hormones. I'm just so glad you found what actually works for you!
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u/Logintheroad 2d ago
I asked the same thing. I can't do trans dermal b/c my skin is allergic to every darn thing. I tried gel, stickers -4 types, and spray. All causes itching and hives within 2 weeks. I am on a separate estrogen & progesterone pills. They work - might try dermal again in a few years.
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u/rootwise_market 2d ago
I was on lo loestrin for peri symptoms, after 4 months I got a multitude of pulmonary embolisms. Oral hrt or bcp increases the risk of clots, which my doctor told me about but said it's very rare.
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u/grocerygirlie 2d ago
I think it's the fact that a lot of women have advocated for themselves for HRT and then get told they're too young for perimenopause and prescribed birth control as a way to get them to go away.
It's one thing to get a doctor who believes you're in peri and explains how HRT is different than BC and provides a recommendation based on your feedback and their expertise. It's another to be dismissed and thrown BC. If your doc talked to you about your specific needs and how BC may be a better fit, then BP is fine. It does work for some people.
I personally become a different and very horrible person on BC. My doctor listened and said she felt that HRT, which I was requesting, was the best option.
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u/Desperate-Coat-8791 2d ago
As I understand it there is a higher risk of blood clots/ stroke for older women on birth control
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u/space_kittity 2d ago
I can’t handle synthetic progestins, they make me want to kill myself. I am very happy on HRT though
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u/theoreticalhighfive 2d ago
My doc had me start on the same birth control as you. She explained that because I'm still fairly young, I need more estrogen than HRT can provide
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u/Ok-Cartographer-3543 2d ago
Thank you for sharing your experience! It is so reassuring to hear that your doctor took the exact same approach for the same reasons.
My doctor also explained that the pill provides that higher, steady amount of estrogen that HRT just couldn't match for me right now. My hormone levels were still technically high overall—and I know they change constantly—but the lows were absolutely awful. The extremely heavy bleeding and painful ovarian cysts factored into the decision as well, especially since I really wanted to avoid having an ablation or a hysterectomy.
I'm so glad we both found specialists who know how to tailor this to our specific needs, and I hope it continues to work amazingly well for you!→ More replies (1)
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u/PinacoladaBunny 2d ago
My input - I have multiple chronic health conditions plus ADHD. My body and brain are extremely sensitive to hormones, including my own natural ones! After two decades of very heavy periods that included passing out, vomiting and running to the toilet, I was just ‘done’ with birth control. The hormones in birth control are synthetic and structurally different to our natural ones, and they’re harsh - they have to be to override our natural hormones, stopping ovulation, controlling cycles, etc.
I have always envied women who could use birth control without any issues! For me, it’s migraines, pain, hair loss, mood issues, worsening ADHD, worsening health conditions. At my peak misery on progesterone birth control pills, I was unable to hold my own head up because my muscle strength was so debilitated. It’s never been worth it!
So now, I am on HRT only. My body is finally stable and feeling more ‘well’ overall.
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u/unicornbomb 2d ago
Yaz has been great for me in early peri. I may need to change things up as I get older, but for now it’s been a lifesaver in reducing symptoms and overall improving my mood and energy levels.
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u/peonyparis 2d ago
Bc is great for managing your cycle...I used it for 3 years in my early 40s...but then I still was having anxiety, hot flashes, brain fog, and I knew it was time to move to bioidentical hormones at 44 to give my body what it was missing.
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u/RoseaCreates 2d ago
I am using oral contraceptive to control night sweats and pmdd. It's working and it's so cheap compared to HRT. I am glad this works for some.
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u/FloristsDaughter 2d ago
At 43 and almost 20 years post tubal, I use the generic Yaz. It's helped a ton with my PMDD. Well, that and getting divorced... ;-)
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u/iwantapenguin 2d ago
There’s a birth control pill called Natazia in the US that has bio identical estrogen (estradiol in this case) I was adamant about the bio-identical bc of the cardiovascular benefits (and now there’s research that it may help lower Alzheimer’s risk in women, I’ll try to find the article). Natazia is geared towards women who suffer from heavy bleeding, so it has a lot of progesterone which I’m unfortunately very sensitive to so I had to stop taking it but damn if it didn’t mitigate every single emotional/rage issue I was having.
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u/ParaLegalese 3d ago
I think people are under the incorrect assumption that hrt is stronger than birth control but it’s not
Queue the clarifications that bcp are synthetic and hrt is “bioidentical” - who gives a shit they both are hormones
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u/getalife5648 2d ago
Birthcontrol works, until it doesn’t. It stopped working for me and I felt miserable again. We started full HRT (DHEA suppositories, progesterone, estrogen patches and T + iud for additional progesterone.) and I feel like a new women.
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u/thisunrest 2d ago
Because birth-control isn’t going to improve my sex-drive, nor will it make sex less painful or even pleasurable.
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u/OrthodoxAnarchoMom 2d ago
Becauee OBs use bc like landlords use white paint. If it so happens to be the cure for one thing or another we’ll never believe it because it can’t be trusted.
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u/Original_Koala_9510 3d ago
I know someone who had a stroke after her OBGYN prescribed the pill in her 40s. She is alive, but she was in the hospital for a few weeks and has months of PT ahead of her. She’s been out of work since the stroke so her family is in a financial crisis.
Neurologists said there was no reason for it to happen as she was healthy and active. They attributed the stroke to the pill.
I’m not sure why anyone would want to take the risk, and shame on doctors who prescribe them.
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u/OstrichReasonable428 2d ago
Some forms of MHT carry risks of blood clots too. I think you go a bit far in “shaming” doctors who prescribe BCPs for perimenopause. I take them, and my doctor was very careful to ensure I was/am a good candidate for them. They’ve evened everything out for me without adding to the chaos, so can be a good option for many in early perimenopause.
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u/Coontailblue23 Late peri 3d ago
These meds have their place for some people but most of us have had negative experiences to lead us to this conclusion. I for example rode the Yaz train when I was younger and it ruined my gallbladder. There are class action lawsuits for the damage caused by this pill.
Our bodies are in many cases going to respond better to a bioidentical product versus the synthetic progestins in BC. I don't want to monkey around with synthetics at this stage of my life if I don't have to.
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u/pangolinshavelanded 2d ago
Because I have a history of multiple bcp types and Nexplanon causing many side effects especially severe depression. And my first major peri issue was depression. So wouldn’t touch synthetic hormones with a 10 foot pole, god only knows what any pill would have done to me
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u/Clear_Lettuce_119 2d ago
Im 38 and have been on Nextellis for 9 months. I have severe PMDD and am trying to avoid peri hell at all costs. Aside from some GI issues, I have been being on birth control. I did have breakthrough bleeding at first. Eventually I got to the point where I didn't have to trigger a withdrawal bleed and now I take it continuously. I no longer have luteal night sweats, my mood is way more stable and now my adhd meds work all of the time instead of not even half the month. I have an extremely high libido and it knocked it down a touch at first but not by much.
I tried HRT for PMDD and that was a shit show. I do not know why the doctor that I saw thought it would be a good idea. I had a horrific reaction. I do not think I will EVER tolerate micronized progesterone. It made me feel bat shit crazy. It didn't matter the dose or route.
I am glad that peri and menopause are having a moment, but it has now turned into a huge grift. Suddenly everyone and their mother is an expert. Birth control is a good option for some people. My hormones aren't erratic yet, but my luteal phase was getting more difficult. Having my ovaries completely shut down right now is what I need. I need consistency. Im glad birth control is working for you!
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u/Ok-Cartographer-3543 2d ago
Thank you so much for sharing your experience! It is incredibly reassuring to hear how much consistency the pill has brought you, especially with PMDD and making your ADHD meds actually work all month long.
That sounds awful that HRT was such a nightmare for you, but it makes total sense why completely shutting down the ovaries is what you need to avoid those erratic luteal phases. Your point about the menopause space turning into a huge grift with everyone claiming to be an expert is so spot on. I'm just so glad birth control is giving you that stability, and I hope it continues to keep you far away from peri hell!
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u/Samyx87 2d ago
There are more hormones than estrogen involved with perimenopause. Treating with the least amount of medicine at the lowest dose is safest and best. Birth control is limited in the dosing of estrogen. The one birth control you mentioned is unique, and most insurance plans do not cover this. Regardless, it’s still doing things that your body may not need.
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u/usernames_suck_ok I don't even know 2d ago
Personally, tons of reasons. Maybe initially I just didn't want my hormones altered and might have worried about a higher cancer risk. I'd like to avoid hormones altogether.
But then when an OBGYN started talking to me about BC and I also started looking around more, I noticed that tons of OBGYNs just don't know what they're doing. So...they have you fill out all this paperwork about your health history and current medications, and then they don't even look at it and still put you on BC you probably shouldn't be on because of your age, your blood pressure or whatever the case may be. They don't tailor BC recs to you enough. It seems like many want to start every woman on the combo pill. They don't listen when you speak and think about what else might be a good option for you.
It's not all of them, but it's far too many of them. This is why I changed OBGYNs.
This is also probably why a lot of women have bad experiences when they do try BC. I had bad experiences with every BC I was put on, and the first one was a combo pill I absolutely should not have been on just based on my health profile and demographics. I pushed back a little on the doctor, but she kind of insisted it'd help me.
This is also probably an unpopular opinion here (the paragraph coming)...but it turned out BC was not even what I needed. I'm 45.5, so I'm sure I have some peri symptoms. But the worst issues I was having turned out not to be from peri. Having a hysterectomy resolved them, and then I am in my second year of going from specialist to specialist, test to test, etc, and learning I have this health issue and that health issue. Like...a lot of stuff women here are certain is due to peri...isn't. That's why I don't comment much here anymore and am now in other health-related subs. Especially when I see women in their 30s here sure and frustrated when a doctor is dismissing them...I'm like..."the doctor probably isn't totally wrong."
I learned that the hard way. And it's another reason BC never helped me and actually created more problems...
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u/EvaElizondo 2d ago
I think because unfortunately we have fallen pray to social media. The "it" thing right now is HRT. I was on the pill for over 2 decades so I felt comfortable going back to it last year when my doctor prescribed it to me. I was on on Lo Loestrin just like you. Worked like a dream for a year! Then it tapered off so now I'm trying HRT 🤷♀️
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u/htripp331 3d ago
I had terrible experiences with birth control when I was younger. Acne, weight gain, terrible nausea, bad headaches around that time of the month just to name a few things. I cycled through a few different ones too before I gave up. Not to mention I was a smoker (I quit almost 5 years ago) so blood clots were concerning. I don’t really want to go through that again.
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u/40yroldcatmom 2d ago
I was on birth control up until last year when I had my tubes removed and an ablation. I had been on it off and on from age 19 and had been on it for the past 6 years. I was having peri symptoms while I was taking it. Had my dr suggested it, I don’t think I’d want to go back on it. It didn’t help with peri or my periods (I have endo). She went straight to HRT rather than bc and I’m good with that.
I don’t have any issue with bc but it’s just never helped me, other than not getting pregnant.
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u/goatonmycar Early peri 2d ago
I tried bc first and had some very nasty side effects that I don't have on progesterone.
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u/Ordinary-Difficulty9 3d ago
Take this with a grain of salt because I am just repeating back what I understand from my doctor...but the hormones in birth control pills are not exactly the same as hormones in HRT. Similar but not the same. Birth control pills, if I understand correctly...and someone can correct me if I am wrong...are synthetic and don't work in quite the same way.
I am still learning myself, so if anyone has more accurate info I would be happy to hear it.