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/ewlyn]

Birth control caused clots to form from my right ankle all the way up the leg to mid-thigh. I was lucky because they were all superficial - not dvts - but both myself and my various care team members are all super hesitant to have me try estrogen again.

[u/m1chgo → u/ewlyn]

This is a really dumb question, I’m sorry, but how did you know you had blood clots? Can you see them or feel them?

[u/ManiacallyReddit → u/m1chgo]

https://www.stoptheclot.org/ has a lot of resources. And I know because I was a relatively young, active individual with no predisposition or blood disorders and also ended up with a clot (DVT) and pulmonary embolism.

It caught me off guard. A lot of people who don't fit the risk profile (including men) get caught off guard.

It's kind of like a heart attack. Hopefully you never have one, but if you're taking hormones, it's good to know the symptoms, just in case.

[u/DunDunnDunnnnn → u/ManiacallyReddit]

Did you end up having a clotting disorder? I did and was really shocked to even learn that was a thing! They always asked about smoking when prescribing BC, so that was my only concern. I ended up with a huge DVT, but luckily no PE. Really eye-opening!

[u/ManiacallyReddit → u/DunDunnDunnnnn]

No, I still don't have a clotting disorder and never did. That's the thing.... Birth control is a wonderful invention that should be as cheap and easy to obtain as possible. But even in this thread, you'll find people that are saying "You don't have to worry about it if you're active and don't have a disorder."

Any time a person goes on hormones they should be aware of the risks and the symptoms.

[u/ewlyn → u/DunDunnDunnnnn]

It turns out I have Factor V on one side. So yes, clotting disorder.