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[Dramy3]

Hi all

I've been reading some articles by Dr Jen Gunter in addition to listening to Dr Newson's podcast and doing my own research.

Wondering why more women don't opt for a continuous birth control pill (combined oestrogen/progestin) during peri--assuming they can get on fine with the progestin side.

My problems all started when I had a hysterectomy and stopped Yasmin that I'd been on for 20 years. Obviously my symptoms aren't all down to that, but just curious why women don't explore this option more as it stabilises everything and gets around the issue of irregular periods.

Would be interested to hear your opinions.

Thanks

[K45]

Discussed this with my GP as a plan B if changing to continous progesterone doesn't work. There should be more options recommended by GPs other than cycling progesterone in perimenopause and continous in post-menopausal. I think every thing I've learnt about hrt is from here or Instagram!

[bombsh3ll]

Fear and lack of awareness would be my guess.

This can be on the part of the clinician as well as the user.

There is a pervasive belief that women over 35 or 40 "shouldn't take the pill" which is not supported by either evidence or guidelines, plus the current social media evangelism about body identical hormones and disparaging of "synthetic" options, as well as a lack of knowledge about the non contraceptive benefits.

A lot of women who would really benefit from the bleed control and/or hormonal stability who are sterile or not sexually active with a male partner think the pill isn't for them because it is labelled as contraception, which is a real shame as they are potentially missing out on an effective treatment.

I also wish more people knew that the UKMEC criteria support COCP use up until the age of FIFTY, and even this only extends to contraceptive use, not therapeutic use ie to help manage a condition, which is an individual clinical decision thereafter.

A lot of people also STILL don't know that periods are completely optional and that it is safe to omit the withdrawal bleeds indefinitely, which I have done for the last 16 years minus a spell when I couldn't get my pill during COVID.

And I also think that instead of the disproportionate focus on a clinically minuscule increase in thrombotic risk and breast cancer, there should be more said about the significant ovarian cancer risk reduction evidenced with long term combined pill use, as well as reduction in endometrial and colorectal cancers.

[Dramy3]

Fear and lack of awareness would be my guess.

This can be on the part of the clinician as well as the user.

There is a pervasive belief that women over 35 or 40 "shouldn't take the pill" which is not supported by either evidence or guidelines, plus the current social media evangelism about body identical hormones and disparaging of "synthetic" options, as well as a lack of knowledge about the non contraceptive benefits.

A lot of women who would really benefit from the bleed control and/or hormonal stability who are sterile or not sexually active with a male partner think the pill isn't for them because it is labelled as contraception, which is a real shame as they are potentially missing out on an effective treatment.

I also wish more people knew that the UKMEC criteria support COCP use up until the age of FIFTY, and even this only extends to contraceptive use, not therapeutic use ie to help manage a condition, which is an individual clinical decision thereafter.

A lot of people also STILL don't know that periods are completely optional and that it is safe to omit the withdrawal bleeds indefinitely, which I have done for the last 16 years minus a spell when I couldn't get my pill during COVID.

And I also think that instead of the disproportionate focus on a clinically minuscule increase in thrombotic risk and breast cancer, there should be more said about the significant ovarian cancer risk reduction evidenced with long term combined pill use, as well as reduction in endometrial and colorectal cancers.

Thanks for all of that insight. I have been thinking about it and Dr Gunter really pushes it. I'm one who cycled Yasmin so only had 2 bleeds a year for 20 years. I like the idea of Zoely but I'm currently only using 1 pump of oestrogel and even that makes me a bit bloated and uncomfortable so not sure 1.5mg oestrodial would suit me. I also had BC 5 years ago and I know an oestrogen-only regimen has slightly less risk of recurrence. However, I don't really pay attention to it as the data are so problematic and it's synthetic oestrogen.

Will discuss at my next checkup with Newson.

Thanks again for the information.

[bombsh3ll]

That's fantastic you've banked 20 years of ovarian cancer risk reduction!

There are some in vitro studies showing NOMAC is relatively neutral on breast cells vs other progestins. That's the progestin in Zoely.

I think it is hard to determine dose equivalents for different routes, as individuals respond so differently, so whilst one pump may give similar clinical effects as 1.5mg oral estradiol in one person, someone else might need 6 pumps to get the same effects as 1.5mg oral.

Do you mind me asking if you are a BRCA carrier?

I'm a non carrier within a BRCA 2 family, and am in the very privileged position of having had BRRM at 29, prior to the availability of genetic testing, but thankful every day that I got in then as I had large dense breasts plus the psychological trauma of having watched it rip through my family, and I would never have been comfortable even with a negative test.

I went on the pill immediately afterwards for ovarian risk reduction and I plan to stay on it until menopause can reasonably be assumed.

[Dramy3]

Thanks again bomb.
I have no family history of BC and my cancer was very slow-growing and confined to the one area of my breast (nodes clear). I was also 42 when it was discovered. Given all of that, I wasn't tested for the BRCA gene. Literally my only risk factor was 20 years of COC use and that's debatable.

Going to discuss Zoely and other COC options with my Newson doctor in the coming weeks. Would be nice to return to the stability i had mentally and emotionally on Yasmin. VA was my main symptom and localised oestrogen didn't help all that much so I know I need a little systemic. The 1 pump of oestrogel seems to be enough. We'll see.

Thanks again for all the info.