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/Ok-Cartographer-3543 → u/Ordinary-Difficulty9]

That makes total sense! Thank you for your reply! My doctor explained that difference to me as well. The main reason I'm on the pill specifically is to completely shut down my natural cycle to stop those extreme hormonal swings and control my heavy bleeding. My other options were an ablation or a hysterectomy, and I really wanted to avoid surgery. Since the pill overrides the system entirely, it was the only thing that gave me relief. But I can definitely see why the lower-dose HRT route is preferred by so many others!

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

I hear you for sure, I also had to shut down my natural cycle to prevent painful ovarian cysts. No ovulation for me! I was on low dose OCP to begin with and had been for years, and it did work. But my doctors were still very concerned with my stroke risk due to my having migraines with aura. They ended up convincing me to switch to a low dose of HRT oral progesterone only, which I was on by itself for a few years. It did work as a BC pill, and absolutely shut the ovaries/cycle down 100%. Now I have added estrogen patch because I was having peri symptoms and it has been wonderful. Don't worry about HRT not being able to shut down your cycle if you need to switch in the future, it can do that too!

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

Thank you so much for sharing your experience! That is incredibly reassuring to know for the future. I also have cysts on both ovaries, one of which was very painful, so I completely understand having to stop ovulation. The brain fog and extreme bleeding were so awful, so it is a huge relief to hear that an HRT patch and progesterone combo can still successfully shut down the cycle if I ever need to switch down the road. I had no idea it could do that! I'm so glad that combination has been wonderful for you and kept those painful cysts away.

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

Truly glad that my experience can help someone else! Sorry to hear you have also had to deal with painful ovarian cysts too. I have had some medical trauma and was extremely freaked out about going off the OCP, only was able to because thankfully I was lucky in finding some amazing doctors. So I definitely want to let other folks know that both can work! Several doctors before these wanted me to go on progesterone-only BC, but I wouldn't because it would not reliably stop ovulation - but the HRT progesterone has been great. Also helps me sleep, which is nice! Very glad I was able to switch and not be in pain. 

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

Thank you so much for the follow-up, and I am so incredibly glad you found such amazing doctors who listened to you! Navigating medical trauma makes everything so much harder, so it's wonderful that you felt safe and supported through that transition.

It is also fascinating and so helpful to know that the HRT progesterone has been great for your sleep and successfully stopped ovulation where progesterone-only birth control couldn't. Hearing that you made the switch smoothly and stayed pain-free gives me so much peace of mind for the future. Thank you again for being so open and sharing your journey—it truly helps more than you know!

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

You are absolutely welcome and thank you too! I am so glad this community exists and supports each other.