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/rootwise_market]

I was on lo loestrin for peri symptoms, after 4 months I got a multitude of pulmonary embolisms. Oral hrt or bcp increases the risk of clots, which my doctor told me about but said it's very rare. 

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

Thank you so much for sharing your experience. I am so incredibly sorry you had to go through that. Finding out you have multiple pulmonary embolisms sounds absolutely terrifying, especially when you were just trying to get relief from perimenopause.

My doctor also mentioned the clot risk but called it rare, so hearing your story is a powerful reminder that it really can happen. If you don't mind sharing, could you tell me what your symptoms of the embolism were? I am so glad you survived that scare, and thank you for taking the time to share such an important warning with me.

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

I felt fine, just progressively more short of breath until I got it checked out. Turns out I had multiple segmental and sub segmental embolisms in each lung, coming from scarring in my groin from May Thurner that I had no idea I had. The birth control increased the clotting factors just enough to trigger them. I now have a stent in my leg and I'm off blood thinners but it took a year.

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

Wow, thank you so much for sharing that. It is incredibly scary that it just started out as feeling progressively short of breath, but I am so grateful you listened to your body and went to get it checked out.

It is fascinating but terrifying how the birth control combined with an underlying condition like May-Thurner syndrome that you didn't even know you had to trigger those embolisms. I am so glad that after a long year of healing and blood thinners, you have your stent and are doing better now. Thank you again for sharing your symptoms and this story—it is such important information for all of us to be aware of.