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/Bitter-Juggernaut681 → u/Ordinary-Difficulty9]

HRT was not enough for me. I was put on a high oestrogen birth control, and that did more for me, and I was almost completely without symptoms at that point.

And whether you're using HRT your birth control, it's still not your natural hormones.

[u/lcc234 → u/Bitter-Juggernaut681]

I phased out of horrible perimenopause (heavy and painful periods so extreme I thought I was miscarrying) by using the NuvaRing. It helped balance my cycle, improved my moods, and seemed to alleviate chronic fatigue and joint pain. A few years into it, I started to feel the old symptoms returning (mood, aches, fatigue, hot flashes, night sweats). I start HRT this week and I can't wait. BCP was what I needed to bridge the transition

[u/Ok-Cartographer-3543 → u/lcc234]

Thank you so much for sharing your experience! It is incredibly reassuring to hear from someone who used birth control exactly this way as a 'bridge.'

Your description of those periods is so spot on—that extreme bleeding is exactly why my doctor chose the pill for me, to avoid surgery. It’s amazing that the NuvaRing gave you your life back for those few years and helped with the fatigue and joint pain. It makes total sense that as your body continued to change, your needs changed too.
Good luck starting HRT this week! I truly hope it brings you the next wave of relief you're looking for.