This sounds like a complicated situation with your susceptibility of blood clots associated with the Factor V condition and taking estrogen/progesterone HRT, which can potentially increase the risk for blood clots.

From my understanding, through personal experience with HRT, is that there is less risk from clotting by using a transdermal estrogen replacement, instead taking oral meds. The oral tablets get processed by the liver where transdermal goes directly into your blood stream. I wonder if that might be a better option for you. But you still may need to balance that out with a micronized progesterone.
I used bio-identical cream going through perimenopause and it made ALL the difference in the world with those horrendous symptoms!

I found a good article that explains it much better than I can! It appears to be a site from Great Britain, but the information is what I wanted to share:
https://www.balance-menopause.com/menopause-library/is-hrt-off-limits-if-ive-had-a-blood-clot/
Doctors generally don’t receive a great deal of education on perimenopause or menopause so it’s just easy to prescribe the standard meds. It takes a little more effort to look into this and research healthier options. You might want to talk to a functional medical practitioner to get another option on treatment options. Or, if you can find a Women’s health specialist who is well informed on Perimenopause/menopause eduction and advancements.

Was this suggestion from estradiol with a primary care doctor, hematologist or gynecologist?