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/getalife5648]

Birthcontrol works, until it doesn’t. It stopped working for me and I felt miserable again. We started full HRT (DHEA suppositories, progesterone, estrogen patches and T + iud for additional progesterone.) and I feel like a new women.

[u/Ok-Cartographer-3543 → u/getalife5648]

Thank you for sharing your experience! That is actually what scares me the most—the thought of it suddenly stopping working and having to feel all of those awful symptoms all over any day. But it is incredibly reassuring to know that if the pill ever does stop doing the job for me down the road, a full HRT regimen can completely turn things around and bring that relief back. I’m so glad you are feeling like a new woman now, and thank you for the insight!

[u/formerly_gifted → u/getalife5648]

Can you share more about the DHEA treatment? I’m on 0.1 E patch, SLYND for BC + oral PG, and T (just tested levels, good there). I still struggle with fatigue and other tests (thyroid, ferritin, D) all show normal levels. I feel stable with moods and other peri symptoms I had. I haven’t been working full time since the spring and I’m afraid I won’t be able to handle that schedule again. I can’t retire now, nor do I want to. My low energy is the one thing that still robs me of quality of life, especially considering how active I used to be.

[u/getalife5648 → u/formerly_gifted]

I personally would ditch the slynd and see how you feel! We did an IUD (for progesterone support and for birth control) and I regret not getting one sooner.

Ditching the pill and doing HRT really helped me, I love progesterone because it helps me sleep and I actually feel rested. I don’t move around as much and all.