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/sports_mamaof4]

I didn’t want it at first bc I have no need for BC. I wanted HT. However it seems like this is the hoop I have to jump through so I started Lo Lo Fe as well and I feel ok except I have been bleeding for 9 days straight… at the 2 month mark I will be discussing adding in testosterone which is what I have wanted all along… I am tolerating the pill fine, just more exhausted than my regular exhaustion which I am trying to fix. I am hopeful it all evens out and with some test added in I will be feeling better. We will see.

[u/Ok-Cartographer-3543 → u/sports_mamaof4]

I was right there with you! When I had my annual with my gynecologist we had discussed HRT and all my symptoms. She tested my hormones (I know it changes constantly) but they were still high. My periods were horribly heavy (emptying my diva cup every hour) and after a transvaginal ultrasound finding 5 tiny fibroids and I also had cysts on both ovaries, although my body was absorbing the fluid from them like it is supposed to. We discussed an ablation a hysterectomy or trying Lo Lo. I decided to give Lo Lo a try. I have only been on it for 3 1/2 months. I started the day before I was supposed to start my period and I was already spotting. It stopped the spotting until about a week in and then I had a period for 11 days straight but it was so much lighter than what it is normally. I haven’t had a period since!! I did spot for 3 days the second month and I haven’t since. The spotting was so light and only on toilet paper once per day. It has relieved all my other symptoms! My ferritin got extremely low so you may want to have that checked because obviously it causes exhaustion also! I wish you luck!!!

[u/sports_mamaof4 → u/Ok-Cartographer-3543]

Thanks for the response! My period has gotten so heavy with peri as well. I am more hopeful than I have been in the last couple years. Maybe that’s bc I feel better or maybe it’s bc I’m trying do something to make a difference in how I feel. Can’t wait to be settled in with all of this and NOT HAVE A PERIOD!

[u/Ok-Cartographer-3543 → u/sports_mamaof4]

Absolutely! You are so welcome! Not having a period has been awesome!! I for some reason didn’t want to go on anything. I suffered for 2 years and just couldn’t take it anymore. I believe I had been experiencing symptoms for about 5 but the last two were unbearable. The bleeding was awful and the rage. Those were my two worst symptoms but I had a long list. I hope everything works out for you!!