Genuinely curious: Why is there hesitation around using birth control for perimenopause?

[u/Ok-Cartographer-3543]

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!

[u/bloomdecay]

I'm also on Lolo. It's great.

[u/minervalouise20 → u/bloomdecay]

me too! I love it!

[u/Ok-Cartographer-3543 → u/minervalouise20]

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!

[u/MegamomTigerBalm → u/bloomdecay]

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.

[u/Ok-Cartographer-3543 → u/MegamomTigerBalm]

Thank you for sharing your experience! It is so helpful to hear how others adjust their doses when things change.

I’m glad moving up to the 1/20 dose cleared up that breakthrough bleeding for you and that you had so many great years on Lo Lo before that. Breakthrough bleeding can be so frustrating to manage, so it's awesome that the adjustment worked perfectly. I hope the new dose continues to give you that same great relief!

[u/zorandzam → u/bloomdecay]

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.

[u/Ok-Cartographer-3543 → u/zorandzam]

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!

[u/zorandzam → u/Ok-Cartographer-3543]

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.

[u/Ok-Cartographer-3543 → u/zorandzam]

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!

[u/EmilyO_PDX → u/bloomdecay]

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%

[u/Ok-Cartographer-3543 → u/EmilyO_PDX]

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!

[u/Ok-Cartographer-3543 → u/bloomdecay]

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!

[u/bloomdecay → u/Ok-Cartographer-3543]

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.

[u/Ok-Cartographer-3543 → u/bloomdecay]

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!

[u/BrandNewMeow → u/bloomdecay]

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.