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[K45]

Hi ladies,

I'm not coping at all atm with sequential hrt. PMT is just horrendous as finished period 1 week ago and now the withdrawal from utrogestan is driving me crazy...stomach cramps, mood swings etc.. Mirena is not an option but I do so much better on progesterone than off it. I'm going to try to resync to my cycle by starting progesterone 8 days earlier. Are there any other options in perimenopause? Has anyone found continuous better for overall wellbeing eg sleep/mood? Would 100 or 200 utrogestan daily then a break days 25-28 be worth trying? Any advice much appreciated!  Thanks x

[K45]

Very quick question- is it better to stop sequential hrt completely if it's having a severe impact on your mental health? I am wondering if  it's better not having the ups and downs of hormones... :-(

[sheila99]

Another option to consider is a combined bcp such as zoely. It avoids the ups and downs but you can't increase oestrogen so is more suitable for those in early peri. Continuous in peri usually means some bleeding unless you use a mirena and you still have the ups and downs of your own hormones. 25/28 is best suited to late peri as it allows a bleed if there's been a build up but you could try it earlier. How long have you been on hrt? If it's recent you might still be on the settling in period and things will improve. It can be useful to keep a diary.

[bombsh3ll]

I take Zoely continuously (I discard the 4 inactive pills) and am a big fan.

No bleeding, no hormonal ups and downs and a miles better quality of life than my friends who are on nothing or been given cyclical hormone therapy

I'm 44 and have no clue how close I am to menopause and no intention of finding out.

Zoely is quite a low dose of estrogen however there are many other combined pills, and some ladies do add a bit of estrogen gel or a patch in addition to Zoely if needed. The progestin is strong enough to cope with this.

The Nuvaring is another good option that I have used in the past, again I skipped the artificial withdrawal bleeds and just changed my ring every 4 weeks.

If you don't want or can't take a combined birth control product, you could also use (off label but supported by the BMS) two desogestrel pills (150mcg) every day as your progestogen with your estrogen of choice.

These should keep you bleed free and shut down your own cycle as it is the same dose of desogestrel as used in combined pills marvelon and mercilon.

If you don't want a synthetic progestin your other option is to take continuous micronised progesterone and accept that you are likely to have some bleeding but may find this more tolerable than seesawing between zero and a higher dose every two weeks, enduring withdrawal symptoms each time.

[K45]

Thanks Sheila for the helpful suggestions -  I've not heard of zoely and will do some research over the weekend. I'm not sure where I'm at in peri but have had various peri symptoms the past 3 years and on sequential hrt 6 months. Everything was going ok up until July when after a family bereavement I had a random bleed 7 days after starting the utrogestan. Then last month again over a week early and had 2 lots of period pain/pmt both months. I am hoping going back to re-syncing hrt starting it 8 days early will help. My GP said next june will review hrt and look to change to continuous. I think I read somewhere that it's ok to reset the hrt if it's wildly out of sync so fingers crossed it will do the trick.

quote author=sheila99 link=topic=70672.msg957264#msg957264 date=1725610525]
Another option to consider is a combined bcp such as zoely. It avoids the ups and downs but you can't increase oestrogen so is more suitable for those in early peri. Continuous in peri usually means some bleeding unless you use a mirena and you still have the ups and downs of your own hormones. 25/28 is best suited to late peri as it allows a bleed if there's been a build up but you could try it earlier. How long have you been on hrt? If it's recent you might still be on the settling in period and things will improve. It can be useful to keep a diary.
[/quote]

[K45]

Thanks Bombsh3ll for sharing your experience with Zoely - it definitely sounds great to not have the horrid ups and downs/bleeding issues common with hrt. Will look into this as well as desogestrel and flag up with my GP if re-syncing hrt doesn't help. Is zoely equal to 2 pumps oestrogel as that's what I'm currently on?

My GP said to try continous next june after 16 months on sequential so as you say that might be more tolerable despite possible bleeding. I think it's really helpful to know there are some options and it's not just sequential hrt or nothing.


quote author=bombsh3ll link=topic=70672.msg957268#msg957268 date=1725611924]
I take Zoely continuously (I discard the 4 inactive pills) and am a big fan.

No bleeding, no hormonal ups and downs and a miles better quality of life than my friends who are on nothing or been given cyclical hormone therapy

I'm 44 and have no clue how close I am to menopause and no intention of finding out.

Zoely is quite a low dose of estrogen however there are many other combined pills, and some ladies do add a bit of estrogen gel or a patch in addition to Zoely if needed. The progestin is strong enough to cope with this.

The Nuvaring is another good option that I have used in the past, again I skipped the artificial withdrawal bleeds and just changed my ring every 4 weeks.

If you don't want or can't take a combined birth control product, you could also use (off label but supported by the BMS) two desogestrel pills (150mcg) every day as your progestogen with your estrogen of choice.

These should keep you bleed free and shut down your own cycle as it is the same dose of desogestrel as used in combined pills marvelon and mercilon.

If you don't want a synthetic progestin your other option is to take continuous micronised progesterone and accept that you are likely to have some bleeding but may find this more tolerable than seesawing between zero and a higher dose every two weeks, enduring withdrawal symptoms each time.
[/quote]