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[Lisakeen]

Hi all, I've found so many posts and replies here so useful, I'm hoping someone will have had a similar experience to me.

The main peri symptom I'm trying to solve is hormonal migraines. Before hrt they would arrive at ovulation and just before a period, so every 2 weeks.
Othe symptoms such as nught sweats are now sorted with 75 evorel patch   

At first I was put on continuous desogestrel (2 tablets a day)
- solved the migraines!!!
- but my mood was destabilised and I was v moody and bloating, putting on a stone in 2 months
- after 3 months of no period I bled for 3 weeks continously.

I asked what else I could try that might not affect mood and weight gain - I was prescribed cyclical utrogestan
- another brand (Gepretix?) But felt great. EXCEPT pre- period migraine came back and heavy  painful periods
-  I've now lost the weight

Where do I go from here?
- GP wants me to stay cyclical, as I'm 45, but I think that's what's causing the migraines

Am I ok to switch to continuous Utrogestan?
Should I try normal dose desogestrel to see if it stops my periods? Will I gain the weight again?

Help!

[CLKD]

   hopefully some1 will be around.

[bombsh3ll]

Cyclical HRT isn't appropriate in the setting of hormonally triggered migraines - you want to flatten out the ups and downs, not exacerbate them.

Bleed pattern should never be prioritised at the expense of your overall wellbeing and quality of life.

There is absolutely no harm or risk of any illness if you were to take a continuous regimen.

The only reason cyclical is prescribed is because you MIGHT get some irregular bleeding on continuous - heaven forbid having to carry some tampons in your bag!

You could absolutely take a single dose of desogestrel daily however this is not considered adequate on its own for endometrial protection, so something else would have to be added eg daily utrogestan.

This may not be enough to achieve full menstrual suppression given you bled on 150mcg desogestrel, but certainly it would be more conducive to hormonal stability.

Mirena IUS is another option. It wouldn't shut down your own ovarian activity but it wouldn't add to the hormone fluctuations as cyclical is doing.

You could alternatively try Slynd as your progestin. Like 150mcg desogestrel this is considered adequate for endometrial protection.

Another option, although this would have to be used with caution in a migraineur, is continuous use of an estradiol based combined pill eg Zoely, omitting the dummy pills. This is what I take and has been an absolute godsend for me. Some specialists will sanction this as long as you have no other cerebrovascular risk factors eg smoking high cholesterol or obesity.

[CLKD]

I believe that there is a new medication approved by NICE for migraines?

[Lisakeen]

Thank-you bombsh3ll. Exactly what I was thinking. I'm trying to avoid the ups and downs. I'll go continuous on utrogestan after this period, which should hit this week, then I'll be starting from thin lining (as fsr as I understand it).

Utrogestan on its own, continuously - is it a case of trial and error to see if it stops the migraines?
Do you know if there is something special about desogestrel that meant I was prescribed it first? (My GP surgery are avoiding me trying to see the women's health specialist again and I'm with the GP, so trying to do my own research!)

[bombsh3ll]

Desogestrel 2 pills daily is strong enough to shut down your own cycle, utrogestan is not.

It also provides contraception if relevant, utrogestan does not.

It keeps most women bleed free if used long term, utrogestan does not.

There's no reason at all why you can't take continuous utrogestan, with or without single dose desogestrel. It will not stop your own hormonal fluctuations but will not exacerbate them as cyclical does.

May I ask, when you were on the double desogestrel, were you on estrogen as well? If you were just on 150mcg desogestrel alone, with no add back estrogen or testosterone for that matter, that is essentially chemical castration as your ovaries would be shut down.

If so it's no wonder you felt like 💩

[Lisakeen]

I was put on an oestrogen patch, with the 2 desogestrel patches, at the same time as I my start to hrt.

But no migraines.

It sounds like I'm good to try continuous utrogestan. And if that doesn't stop the hormonal migraines, I should add 1 tablet desogestrel.

The GP suggested desogestrel plus cyclical utrogestan, but that sounded like the worst of all combinations!

[Mary G]

This may or may not be of interest but my hormonal migraine specialist is a massive fan of Cerazette.  I'm many years (15+?) post menopause but she suggested I take one single 75 mcg dose every day alongside one or two pumps of Oestrogel.  Perhaps the problem was you were taking too high a dose (ie double) and you were cancelling out the positive effects of the oestrogen?  This often happens when women are dosed up to the eyeballs on progesterone.

Hormonal/menopausal migraines are her thing and she has had a lot of success with Cerazette and the good news is, it's available over the counter.  Migraines are linked to bleeds so it's important to achieve amenorrhea which is difficult with Utrogestan which made my migraines worse.

I hope that helps.

[bombsh3ll]

That sounds like a good plan.

I agree there's little point taking cyclical HRT alongside desogestrel.

It sounds as if they perhaps don't have a great deal of experience with HRT and are just rigidly sticking to the flow chart based guidance to prescribe cyclical if peri, conti if 12m post, without any real understanding of the rationale or clinical exceptions to this.

[Lisakeen]

Mary G - you are right. Cerazette is the brand name of desogestrel (generic).

But 1 tablet isn't enough protestin to use as hrt.

It sounds like desogetrel / cerazette (1 tablet) plus continuous utrogestan might work for me! As long as I can tolerate the progestin side effects.

Thank you all. Wish me luck!

[Mary G]

Mary G - you are right. Cerazette is the brand name of desogestrel (generic).

But 1 tablet isn't enough protestin to use as hrt.

It sounds like desogetrel / cerazette (1 tablet) plus continuous utrogestan might work for me! As long as I can tolerate the protesting side effects.

Thank you all. Wish me luck!

Good luck and please let us know how it goes.

Hopefully the Cerazette will mean you achieve amenorrhea which will keep the migraines away and make the Utrogestan tolerable.