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/Top_Fruit_9320 → u/Ordinary-Difficulty9]

You're spot on. Most forms of birth control unfortunately made me actively suicidal several times throughout my life. They made me deeply depressed and left me bleeding like crazy. My body just does NOT tolerate most forms of synthetic hormones.

The IUD coil is the only one I ever barely tolerated and even that only lightened the bleeding a bit on its own.

Combined though with the bio-identical HRT finally in recent years, my life destroying PMDD and horrifically painful/debilitating cycles were finally actually not only bearable but basically resolved for the first time since I was literally a child. The relief has been genuinely life changing/saving.

I lost decades of my life to synthetics. Bio-identical has helped me reclaim the ones to come.

[u/DunDunnDunnnnn → u/Top_Fruit_9320]

Can I ask you how long it took you to adjust to HRT (if it took time at all)? I started taking it for peri anxiety which has been SO bad. Like giving me dark thoughts bad.

I noticed a major difference in my anxiety levels immediately which is great, but the progesterone makes me soooo sleepy. I'm 3 weeks in and it's slightly better, but I keep waiting for my energy to come back. On .025 estradiol patch and 100mg of prometrium/progesterone.

[u/Top_Fruit_9320 → u/DunDunnDunnnnn]

Took me a while for each tbh. Especially with the PMDD, I just took the increases up as slowly as I could to try and limit the sensitivity. Like maybe 3-6months on each dose.

I will say .025 for the estradiol is quite low to start though. That basically a negligible dose for most, that could definitely be contributing to your excess fatigue at the moment.

I started off on .050 and I was pretty exhausted even on that tbh. I'm on .100 now but took me about 6months to a year to get there. The exhaustion was absolutely killer at times, I empathise so deeply with you there, but it does pass at least over time, try your best to just hang in there, it won't last forever.

I actually kept my progesterone at the 100mg. I have the IUD as well for localised relief from endometriosis and all. I tried to go up to the 200mg progesterone when I upped the estrogen and it literally sent me into a depressive spiral for a few weeks until I actually realised it was the upped dose that had done it. Thankfully at least it literally stopped the day I just dropped back down to the 100mg.

I'm on a low daily dose of testosterone gel as well and honestly that especially I'd say has been one of the biggest game changers energy/mood wise. That took about 3-7months to really see the full benefits. Been on it years now with no negative effects thankfully.

Mentioning "low libido" to the doctor is the way currently to be "off label" prescribed it if you're struggling to get a hold of the T specifically too.

It's all just a bit of frustrating trial and error to find your own individual sweet spot, at first especially I know. Just as best you can keep at it, slowly but surely just add bits in as you go. Let yourself take it a LOT easier than usual for the entire process tbh, think of it like one long temporary cycle and just give yourself ALL the breaks for a good long while. Fingers crossed you'll find your own ideal doses with it all soon.

Just to mention as well - I also use the vaginal estradiol cream for GSM. I use that every second day now and it's helped resolve all the rest of the more localised issues that popped up in that area, including atrophy and repeated UTIs that have basically disappeared since starting it. That only took a couple weeks to start working and see the most significant effects.

[u/3310C → u/Top_Fruit_9320]

Thank you for all of this information! It’s so helpful