Mini pill and continuous or sequential ultrogestan?

[Thematic]

I’ve been on the mini pill for a year in an effort to suppress my periods as I’ve been having some crippling gastro problems in the few days before my period starts. It’s worked great. Now I’ve started HRT (I’m 47 and was still having regular periods a year ago when I started the mini pill but have been advised to try HRT by consultant due to recent onset of osteoarthritis which seems linked to dropping hormone levels) and have had ultrogestan added into the regimen alongside the desogestorel.

The Gp has said 200mg for 12 days but I’m wondering about whether this would be sensible in my circumstances as I definitely don’t want to have a period as this will bring back my gastro problems. I’ve read everything I can find but cannot find any rationale for sequential HRT except it makes women have a period, though can’t find any info as to why this is necessary. Every source I can find says sequential in perimenopause (which applies to me) and continuous after menopause (not me). But as the mini pill suppresses my period, do i therefore take 100mg once a day instead? There seems little published data on desogestorel during HRT. My GP won’t prescribe 2x desogestorel as it’s off-label.

any advice welcome please. (I’m a scientist so any links to published papers would be useful too!) I’d like to speak to my GP again but they’re always so busy so would like to go in armed with good info if I want to ask for a change. Thanks

Should also add that I’m not a candidate for merina- I’ve tried it twice and both times it’s caused chronic insomnia and joint pain (I have Ehlers Danlos syndrome and don’t get on well with androgenic progesterone).

Can you explain what sort of estrogen you're using? If a consultant has put you on this, what progestogen are you using with it?

Are you still using the mini pill?

So are you asking if you can take all 3- estrogen, the mini pill and Utrogestan?

The mini pill can - in the right dose- be used as part of HRT - but your GP won't offer this, I imagine as it's off-licence. (I was offered it by my consultant, but decided to try Utrogestan.)

You're right that you will probably get a withdrawal bleed on Utrogestan .

It may not be a great idea to overdo the two progestins- it should be one or the other.

You could try Utrogestan daily. The downside is you may get spotting as it may not control your own periods.

I was on the mini pill & took utrogestan 100mg continuously alongside evorel patches for 10 months. I had no issues & no bleeding. I’ve got the coil now because of the stock issues with utrogestan at the time.

Were you perimenopausal or menopausal @Offredismysister ?

I'm 43 and came off the mini pill permanently last year after taking it since I was 17 (except for when I had my 3 kids).
I had no idea it was causing me my anxiety but in retrospect it most definitely was!
I feel so much better now I'm off it.

@JinglingSpringbells I'm on Oestrogel 1 pump at the moment. I think I already explained the rest didn't it? 75mg desogestroel and GP has prescribed 200mg ultrogestan for 12 days per month. I don't want to stop the desogestorel (mini pill) as its doing a good job stopping my periods which I need to cope with my gastro problems. They won't prescribe 2 x desogestorel, so I have to combine with the ultrogestan. I want to know if I'd be better taking 100mg every day as a continuous regime.

I don't have a consultant with regard to HRT - the consultant I referred to is an arthritis consultant.

@Thematic I’d not had a period on the mini pill for 6 years & no one has ever said if I’m peri or menopausal. I’m guessing peri as I’m only 46.

I found this in the NICE guidelines to back it up.

cks.nice.org.uk/topics/contraception-progestogen-only-methods/management/progestogen-only-pill/

Thanks @booktokbear but that doesn’t really answer my question. I’m not taking desogestorel for contraception, I’m taking it to suppress periods. What I want to know about is whether I can take ultrogestan as continuous or cyclical HRT when I’m taking merina as well. I can’t find any published data on WHY perimenopausal women need to take cyclical progesterone as HRT instead of continuous, except to give them a period, which I have to suppress.

Apologies.

I'll get my post deleted as it took a lot for me to post it.

I forgot to say I was on the mini pill to suppress periods, not for contraception as my husband has had a vasectomy.

My GP prescribed, she runs a weekly women’s health clinic at the surgery & contraception & menopause is her special interest.

@Thematic If you take Utrogestan daily, it should prevent a period anyway.
It's a no-bleed type of HRT.

There shouldn't be any need to use the mini pill as well.

You are on a very low dose of estrogen. Using Utrogestan daily may thin the lining enough to prevent it shedding.

There is a RISK that in peri, your own hormones may overpower the low dose of Utrogestan but you can't tell until you try it.

@Thematic Look at the Menopause Matters website under HRT/ preparations/ for post menopause.https://www.menopausematters.co.uk/postmeno.php

There is a page there on when women are can move to daily progestogens and what may happen if they are not post menopause.

@Thematic I would take it continuously if I were you as it may bring on a withdrawal bleed and cause your symptoms.
the reason peri women are prescribed HRT cyclical is because their periods are working in the background. If taking continuously periods can breakthrough and cause irregular bleeding x