Birth control options

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My wife, 40 yo, has been on oral BCPs for ~20 yrs. She is interested in optimizing her hormones, but has been told she must be off the pill first. Are the hormone containing IUDs okay to use while with HRT/TRT in women? It doesn't seem like the low dose of local intrauterine hormone would make that much of a difference, but her doc seems to think so.

An added wrinkle is that she has a remote history of ovarian cysts (none in 18 years) and worries about them coming back after discontinuing the BCPs. IUDs increase the risk for ovarian cysts, but can that risk be mitigated by optimization of systemic hormones?

The more I type, the more it feels like there is a vasectomy in my future.