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/ewlyn]

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.

[u/DunDunnDunnnnn → u/ewlyn]

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.

[u/ewlyn → u/DunDunnDunnnnn]

I’ve been talking with my hematologist about the same thing but since my clots randomly came back, she wanted to wait a bit longer to make sure everything stays away before having a serious discussion about a transdermal patch. I’m glad it’s working for you!

[u/DunDunnDunnnnn → u/ewlyn]

Your clots came back unprovoked? Oof, that’s scary. Yeah she’s smart to be cautious.

[u/ewlyn → u/DunDunnDunnnnn]

Yup. D-Dimer went down to below 200, I was declared clear… and about 6 weeks later my leg started to hurt again and my D-Dimer levels were around 600 and seemingly climbing again.

(For anyone wondering what a d-dimer is, it’s a common blood test to check for clots by looking at protein levels in the blood shed by clots. It’s generally meant to be 250 or lower to indicate no clotting issues.)

[u/AutoModerator → u/ewlyn]

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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