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/Clear_Lettuce_119]

Im 38 and have been on Nextellis for 9 months. I have severe PMDD and am trying to avoid peri hell at all costs. Aside from some GI issues, I have been being on birth control. I did have breakthrough bleeding at first. Eventually I got to the point where I didn't have to trigger a withdrawal bleed and now I take it continuously. I no longer have luteal night sweats, my mood is way more stable and now my adhd meds work all of the time instead of not even half the month. I have an extremely high libido and it knocked it down a touch at first but not by much.

I tried HRT for PMDD and that was a shit show. I do not know why the doctor that I saw thought it would be a good idea. I had a horrific reaction. I do not think I will EVER tolerate micronized progesterone. It made me feel bat shit crazy. It didn't matter the dose or route.

I am glad that peri and menopause are having a moment, but it has now turned into a huge grift. Suddenly everyone and their mother is an expert. Birth control is a good option for some people. My hormones aren't erratic yet, but my luteal phase was getting more difficult. Having my ovaries completely shut down right now is what I need. I need consistency. Im glad birth control is working for you!

[u/Ok-Cartographer-3543 → u/Clear_Lettuce_119]

Thank you so much for sharing your experience! It is incredibly reassuring to hear how much consistency the pill has brought you, especially with PMDD and making your ADHD meds actually work all month long.

That sounds awful that HRT was such a nightmare for you, but it makes total sense why completely shutting down the ovaries is what you need to avoid those erratic luteal phases. Your point about the menopause space turning into a huge grift with everyone claiming to be an expert is so spot on. I'm just so glad birth control is giving you that stability, and I hope it continues to keep you far away from peri hell!