Mini Pill and Estrogel

[BatsAtHome]

I have been on Estrogel (2 pumps per day) and Utrogestan (100mg/2 per day/12 days of cycle) for 6 months.
Feeling (a lot) better but still have crashes.
I've been to the doc today and asked for mini pill. She surprised me by saying I now won't need the Utrogestan part of the regime - if she gives me the right mini pill.
I'm a bit worried about giving up the Urtogestan. I like that part of the regime when I sleep fully and feel quite zen.
She said that, if I wanted to, I could still take the Utrogestan but only 1 per day. I'm assuming she still means for half the cycle not daily. So that was still included in my prescription.
So I have been given Desogestrel as the pill and the Estrogel as normal. Now I'm just not sure whether to take the Utrogestan or not.
Just wondering if anyone has similar experience and can share?

Which mini pill is it and has she told you to take two a day or one? Because one 75 microgram desogestrel pill doesn't contain enough progesterone to protect the womb so you would still need utrogestan or some other form of progesterone.
It also seems a bit weird she's told you you can take utrogestan if you want. I would query that.
(My GP told me the guidance had changed and one deso pill was ok but another GP queried it a few months later and she was right to - original GP made a mistake so they've put me on two a day.)

Thank you. That's what I wanted to query really, I obviously want the right amount for the womb protection. It's Desogestrel 75 mcg one per day. I said I was loathe to give up the Utrogestan and she said I could still take it, but shouldn't need to, and could take 1 per day.

I spoke with my GP yesterday. She said the latest advice for our area is that it's ok to use 75mcg desogestrel as the progesterone component of HRT. She said that advice had only recently changed. She was great actually and she said she does stay up to date with meno advice and receives alerts and updates from Newson Health so I feel confident in her. However, I can add the utrogestan if I want to as it won't hurt and aids my sleep. There's not really a definitive answer it would seem - only ever-changing latest advice.

Hmm, ok. My GP said that the advice had "recently changed" (i.e. that single deso was ok) back in July but I could find no evidence of it online. I asked the British Menopause society about it in November (you can pay £10?ish to ask a question) and they said it hadn't and one was not enough. Then another GP reviewing my meds challenged the original GP about it and he then said I needed two.

I'd really like to know because 2 per day is giving me absolute bastard headaches and I would like to go back to one.

I'm not keen to take double deso (150mcg). I think what I will do is take the 75mcg deso daily and then take 100mg Utro for 12 days of the cycle. I'm not sure what else I can do really. I'll ask for clarification again next time I'm at the docs.
Doing the maths;
200mg of Utro over 12 days (sequential HRT) is approx. 80mg prog per day over the month
100mg of Utro every day (continuous HRT) is obv. 100mg prog per day over the month
75mg of Deso every day is obviously 75mg prog per day over the month
Not much difference to the sequential regime then? Just spread out.
But if I add the 100mg for the 12 days that works out about 115mg of prog per day over the whole month.

75 micrograms of deso per day, not milligrams. So approx 39 mg progesterone per day if taking 100mg utro on 12 days, plus the 75 micrograms per day from the deso. 39.075mg. Not 115mg.

(But you can't really compare the two progesterones so I've been told.)

According to this, top of page 7 "Earlier studies" bit:
thebms.org.uk/wp-content/uploads/2022/12/14-BMS-TfC-Progestogens-and-endometrial-protection-NOV2022-A.pdf

it says that with 75mcg deso you need 100mg Utrogestan daily or 200mg for 12 days.

I promise I will shut up and go away now.

Please don't shut up and go away :) Thank you, that is helpful.
Oh, micrograms is tiny.....
As well as needing the endometrial protection I also feel miles better with plenty of progesterone, so I'm definitely going to supplement on top of the mini pill.

I am under an nhs gynaecologist and the Newson health clinic and both have agreed for me to take oestrogel 2 pumps (sometimes 3), the mini pill and utrogestan 100mg every single night. So that’s what I’ve done for nearly 3 years now. No one has contacted me to change anything or to amend my prescription so I shall carry on! (I’m 42 and been in early menopause since 37 due to autoimmune issues).

Thanks for this. I will continue with the Utro but sequentially (although I also don't understand that bit as on the mini pill I probably won't have a period anyway....).

Ha, no worries, I just didn't want to bang on and on, or for you to feel hectored.

I do wonder whether the current shortages of utrogestan have led them to re evaluate the use of it in HRT and they’ve now realised it’s been over prescribed perhaps? Curious.

This from that BMS report; no mention of desogestrel but clearly a marked difference in amounts according to the type of progesterone
Progestogen doses within HRT regimens
Based on Cochrane evidence, the suggested dose of progestogen given in a continuous combined HRT regimen would be a minimum of 0.5 mg/day of norethisterone or 2.5 mg/day of medroxyprogesterone acetate. For low-dose sequential regimens norethisterone a minimum of 1mg/day given for 10 days a month, oral micronised progesterone 200 mg/day for 12 days a month, medroxyprogesterone acetate 10 mg/day for 10–14 days a month or dydrogesterone 10 mg/day for 14 days a month would be suitable options.11
Does Desogestrel maybe have more in common with norethisterone than utrogestan regarding it's efficacy at those doses?

Hi I'm on everol 50 sequi and desogestrel (I had to get deso from family planning as my GP refused to give me it as she believed I couldn't get pregnant but she was only going by fsh levels and these can fluctuate all the time) I've never had a period on the mini-pill before as I had been on it for 7 years but I've been getting spotting for several weeks and menopause symptoms have returned do I need to change my dose

Hi I know this is a super old post but just wondered if you continued on just desrogesteol & estrogen without extra progesterone. I’m on desrogesteol and 2 pumps oestrogen but the extra progesterone made me feel awfully depressed and wondering if I can just take desrogesteol alone