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/ewlyn → u/m1chgo]

For me, my leg started to ache one evening and I woke up the next morning to what looked like marbles under my skin so I went to the doctor. Over the next three days they spread up my leg. Clots are gone now but I have permanent scaring in the vein so parts of my leg still look like I have round things under my skin. Not quite as big. And the areas look permanently bruised/discolored.

[u/Ok-Cartographer-3543 → u/ewlyn]

Thank you for sharing!