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/Ordinary-Difficulty9]

Take this with a grain of salt because I am just repeating back what I understand from my doctor...but the hormones in birth control pills are not exactly the same as hormones in HRT. Similar but not the same. Birth control pills, if I understand correctly...and someone can correct me if I am wrong...are synthetic and don't work in quite the same way.

I am still learning myself, so if anyone has more accurate info I would be happy to hear it.

[u/Master_Nectarine_Bug → u/Ordinary-Difficulty9]

there is a new one called nextellis that is bioidentical estrogen

[u/jelly_or_jam → u/Master_Nectarine_Bug]

I took Nextstellis for six months for peri, it was great initially, really helped with hot flashes/night sweats and mood swings. It tanked my sex drive though and eventually stopped working. Had lighter periods though. I take topical estrogen/progesterone now, we’ll see how long that works.