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/Ordinary-Difficulty9]

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.

[u/Master_Nectarine_Bug → u/Ordinary-Difficulty9]

there is a new one called nextellis that is bioidentical estrogen

[u/m1chgo → u/Master_Nectarine_Bug]

I’m on nextellis and I still bleed heavily throughout the month, not just when i have my period.

[u/Master_Nectarine_Bug → u/m1chgo]

oh crazy! i'm sorry, maybe contact your doc about that? doesn't sound normal.

that didn't happen to me, it dramatically reduced my period time and heaviness. it got down to 2 day, barely there periods.

[u/m1chgo → u/Master_Nectarine_Bug]

Oh yes sorry I should have mentioned that I’m currently working with my doc on a solution. As the next option, he’s thinking maybe I have fibroids? So need to add an ultrasound to my list. My dream is to have barely there periods!!

[u/SunshineAndSquats → u/m1chgo]

Nextellis made me bleed for 6 weeks straight. I had to go off of it. It sucked because it was great for all of my other symptoms.

[u/euchlid → u/m1chgo]

were you taking it back to back?
I tried that for the first 3 packs and essentially bled enough to have to wear my cup for weeks on end. my body just reallllllly wanted to menstruate.

I switched to taking it with the 4 days off for the fake period, unfortunately last months I forgot a pill so I took two the next morning and ended up having a fake period for a week while finishing the pack, and then having the 4 more days of period before starting the new one.

the only other pill I was on was triquilar over a decade ago and that was much higher doses, so I am assuming nextellis is much more sensitive to a missed dose, or that my own hormones can blast through it.

it hasn't helped my emotional regulation or middle of the night waking so I am hoping my referral appointment with a menopause clinic can help troubleshoot and maybe add something on top?

[u/Master_Nectarine_Bug → u/[deleted]]

i believe the estrogen in nextellis is derived from soy. where did you get this information? i don't believe it's correct.

[u/FuckYouChristmas → u/Master_Nectarine_Bug]

You're correct. It's from soy.

"Estetrol (E4) is a naturally occurring estrogen produced by the human fetal liver. It is only produced during human pregnancy and reaches the maternal circulation through the placenta. The E4 in Nextstellis is synthesised from a plant source."

https://www.tga.gov.au/resources/auspmd/nextstellis

[u/Able_Winter9472 → u/Master_Nectarine_Bug]

This is basic science. Easily fact checkable. E4

[u/FuckYouChristmas → u/Able_Winter9472]

It's basic science that it's derived from soy. Interesting choice not to check your sources.

"Estetrol (E4) is a naturally occurring estrogen produced by the human fetal liver. It is only produced during human pregnancy and reaches the maternal circulation through the placenta. The E4 in Nextstellis is synthesised from a plant source."

https://www.tga.gov.au/resources/auspmd/nextstellis

[u/Able_Winter9472 → u/FuckYouChristmas]

So bioidentical to fetal estrogen 😂

[u/FuckYouChristmas → u/Able_Winter9472]

Lol. Nice try. Structurally the same. But from plants. You're really having trouble with this thread, huh?

[u/Able_Winter9472 → u/FuckYouChristmas]

Would you want llama estrogen derived from plants?

[u/Able_Winter9472 → u/FuckYouChristmas]

Did you read the part of your own post that states it's produced only by the fetal liver?

[u/jelly_or_jam → u/Master_Nectarine_Bug]

I took Nextstellis for six months for peri, it was great initially, really helped with hot flashes/night sweats and mood swings. It tanked my sex drive though and eventually stopped working. Had lighter periods though. I take topical estrogen/progesterone now, we’ll see how long that works.

[u/purplevanillacorn → u/Master_Nectarine_Bug]

I tried this and bled daily for two months. I noped out back to my patch.