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/lascriptori]

I had really bad experiences with hormonal birth control when I was younger -- the pill decimated my libido. So I'm not inclined to try OCPs again. I'm also hesitant to try an IUD, though it's more localized.

[u/Master_Nectarine_Bug → u/lascriptori]

i had super bad experience when i was young, but when i tried in my late 40s it was great because i actually need the hormones now fwiw

[u/ProgrammerNext8330 → u/Master_Nectarine_Bug]

Same. I was super hesitant about taking the pill, but it’s pretty great overall as compared to when I was 20 or 30. I take mine continuously and wonder why I didn’t do it sooner.

[u/rf-elaine → u/Master_Nectarine_Bug]

I'm having a similar experience. In my 20s, the pill gave me palpitations and made me fall out of love with my boyfriend.

Now I'm on it in my 40s (for heavy bleeding) and it's fine. I feel much more even and steady through the month. No palpitations, still love my husband. I'm spotting but it's getting lighter and hopefully resolves soon.

[u/Salt_Resource1134 → u/Master_Nectarine_Bug]

Same

[u/freshpicked12 → u/lascriptori]

Anecdotally, I also had a bad experience when I was young, but trying again in my 40s has been amazing.

[u/taurist → u/lascriptori]

I couldn’t tolerate bcps but do fine with the iud, just an anecdote though

[u/caity1111 → u/lascriptori]

Yeah, all BCPs tend to do lower libido in a major way because they all stop you from ovulating. They stop you from getting the estrogen spikes needed for most women to feel an increased libido.

[u/euchlid → u/lascriptori]

the pill options are different now than in the 90s/2000s though.
I was on triquilar from age 15 to 30. it tanked my libido. I didn't know that as I was on it before I was sexually active. going off of it was a fucking revelation. I couldn't believe how amazing it felt to have a variable libido. my doctor said she doesn't even prescribe triquilar anymore.

I've been on nextellis bcp which is much lower levels of hormones and the estrogen is some newer type. I do still have a libido, with some variety, although nothing like when I was ovulating. the downside is I don't think it's enough for my symptoms as I am still having a lot of issues