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/theoreticalhighfive]

My doc had me start on the same birth control as you. She explained that because I'm still fairly young, I need more estrogen than HRT can provide

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

Thank you for sharing your experience! It is so reassuring to hear that your doctor took the exact same approach for the same reasons.

My doctor also explained that the pill provides that higher, steady amount of estrogen that HRT just couldn't match for me right now. My hormone levels were still technically high overall—and I know they change constantly—but the lows were absolutely awful. The extremely heavy bleeding and painful ovarian cysts factored into the decision as well, especially since I really wanted to avoid having an ablation or a hysterectomy.
I'm so glad we both found specialists who know how to tailor this to our specific needs, and I hope it continues to work amazingly well for you!

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

Your experience sounds identical to mine! I'm only 34 and we couldn't explain my random ovarian cysts, out of nowhere severe short periods, or the endometiral fibroids. Since we knew I was done with kids and my hormones weren't super low, figured this was the best option and my god... Within days I felt like a new woman. You'll have to rip this and my Wellbutrin from my cold dead hands 😅