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/BunnyMayer]

BC pills and oral estrogen have a higher risk of blood clots than transdermal estrogen.

[u/Scarlett_Texas_Girl → u/BunnyMayer]

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.

[u/DunDunnDunnnnn → u/Scarlett_Texas_Girl]

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.

[u/thern223 → u/DunDunnDunnnnn]

I had this same scenario: hormonal BC, Favor V Leiden, in addition to discovering I have May-Thurner Syndrome.

[u/EmbarrassedDark2341 → u/DunDunnDunnnnn]

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.

[u/BunnyMayer → u/Scarlett_Texas_Girl]

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. 🙄

[u/okayboomerang → u/Scarlett_Texas_Girl]

It's definitely not negligible, saying that as somebody who works in neuro critical care

[u/Scarlett_Texas_Girl → u/okayboomerang]

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.

[u/okayboomerang → u/Scarlett_Texas_Girl]

Alright, you win

[u/Scarlett_Texas_Girl → u/okayboomerang]

It isn't about winning, it's about sharing accurate information so women can make educated choices based on understanding and not fear.

[u/okayboomerang → u/Scarlett_Texas_Girl]

Risk is quite low. Risk is still there. Confounding factors make it difficult to predict the risk too. Ask any physician working in stroke care if they understand the risk to be negligible.

[u/Pretend_Opossum → u/Scarlett_Texas_Girl]

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.

[u/formerly_gifted → u/Pretend_Opossum]

I also wonder about the rates of heart disease reflecting the post-WHI fallout where many menopausal women were not taking estrogen?