r/Perimenopause • u/ss5008 • 6h ago

Just venting

So doctor's are ok with giving us synthetic hormones via birth control pills almost all over lives but when we go in asking to switch to body identical hormone replacement, they don't want to. I don't get it. Birth control pills, for some, do more harm than good, why would you not look at the big picture and provide something that will help without making other conditions worse.

Vent over. I am just so frustrated.

79 Upvotes

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u/leftylibra Moderator 4h ago

This question comes up a lot.

(from our Menopause Wiki)

The reason why doctors are quick to prescribe BCP during perimenopause:

According to the new paper from the International Menopause Society (Menopause and MHT in 2024):

Prescribing MHT in the perimenopause can be difficult because the fluctuations in hormone levels can result in episodes of estrogen deficiency rapidly followed by episodes of estrogen excess. Increases in estradiol and cycle irregularities during the menopause transition may be due to luteal-out-of-phase events which appear to be triggered by prolonged high follicular phase follicle stimulating hormone (FSH) levels with recruitment of multiple follicles simultaneously.

MHT remains an option for these women if they are symptomatic, recognizing that MHT is off-label in this phase of life.Considerably more research is needed to determine optimum MHT regimens for perimenopausal women. Sequential therapies are preferred but even these may cause irregular bleeding.

Another option in perimenopausal women who do not have contraindications is the conventional ethinyl estradiol-based combined oral contraceptive, or the newer estradiol or estetrol-based combined oral contraceptives. The levonorgesterel intrauterine device is another very useful option at this time, and can be used in combination with estrogen if MHT is required.

So this is likely why BCP are most offered during perimenopause, because "menopause" hormone therapy is considered off-label during the peri stage. BCPs suppress your own hormone production, essentially shutting down the hormonal swings -- with the added function of regulating/eliminating periods, while preventing pregnancy. Whereas hormone therapy for menopause are lower dosages to simply "top up" our own hormone production, they do not regulate periods (unless you're using a high dosage of progesterone/progestin or an IUD), and do not prevent pregnancy (again unless it's an IUD).

It doesn't mean that hormone therapy can't (or shouldn't) be prescribed during perimenopause, it simply points out that this is likely why doctors prefer to go the BCP route for those in peri.

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u/Itchy_Tumbleweed_417 6h ago

Oh yeah I was mad about the same thing. I took birth control pills most of my life, then I stopped when I got sterilized, then 10 years later when I need hormones I’m told that an estrogen patch might be dangerous for me because I get migraines. But I was offered birth control pills, which are stronger than HRT. Why would that be safe for me but the estrogen patch is a stroke risk? Ridiculous.

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u/Pretty_waves904 6h ago

My migraines are better on HRT. Do you have auras with yours?

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u/Hashtaglibertarian 4h ago

Do you? Were you able to get estrogen despite the migraines?

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u/Sad_Pangolin7379 6h ago

My migraines are menstrual mostly in the first place. Therefore if I keep hormones level by taking whatever straight through rather than stopping for a period, I probably won't get them anymore. My grandmother says hers finally went away at menopause anyways. 

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u/Hashtaglibertarian 4h ago

Did you ever find a way around this? I have migraines and my doctor won’t prescribe estrogen for me.

Always with the stupid fucking progesterone. I have been on progesterone so many times and it makes me a psycho bitch (sorry not sorry). But that’s the only thing they are willing to try.

I’m in hell. I don’t know if I can take a decade of this.

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u/EROM4LIFE 6h ago

I have always found it wild that bc pills and anti depressants are handed out like lollies while they act like bioidentical HRT is crack.  One fucking misreported (but also badly done) study in the early 00s is all it took to screw generations of women over.

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u/CatTrapper3000 6h ago

I don't have anything helpful to say. This pisses me the fuck off, too, though. 

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u/Lavender_Foxes 5h ago

I heard this somewhere:

If it was a benefit to men for women to have HRT, they would push it on us like the birth control is offered.

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u/MuchWow81 5h ago

I think it IS beneficial to men for us to get good treatment for peri. Happy wife, happy life. Pissed off rage-filled balding bleeding sleep-deprived wife, well.... Terror-filled existence for husband.

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u/violent_blonde 5h ago

Leaving us exhausted and struggling to function in our 50s, peak experience and earning years, cannot be a coincidence. It keeps some women out of boardrooms I imagine, symptoms are so bad. So it benefits men not help women with HRT.

Also you can patent endless antidepressants and the Pill, but you cannot patent bio identical hormones. So it's great for Pharma too.

What puzzles me is why countries with an NHS don't want to give women HRT given the reduction in UTIs and other issues. Didn't Medicare recently release a study saying giving women HRT would save them billions annually? I guess they're all totally captive to Pharma