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[Dotty]

https://thebms.org.uk/wp-content/uploads/2023/04/14-BMS-TfC-Progestogens-and-endometrial-protection-APR2023-A.pdf

Page 7 talks about desogestrel

[CrispyChick]

Thanks Dotty.

It's not particularly strong... But at least it's something. X

[dangermouse]

I suppose there’s an argument for having a small but steady amount of E and P in the blood that may stop the brain from causing the surge and plummeting of E in late peri.

It’s not the same as overriding the cycle with E, where very large amounts desensitise the receptors (and whatever the progestins do in this regard) but could create some stability.

I had assumed that my reaction from E in peri was due to it pushing the spike up even further but I still get a version of it now when E is added and my levels are very low.

[CrispyChick]

Yes. I'm unclear if even double mini pill is sufficient in my situation.

Whilst I acknowledge the role progestin plays in stopping ovulation. Is this sufficient??? I'm reading high dose estrogen plays a role - and, in this respect, I can see why low dose coc weren't as successful for me as higher dose.

"Combined oral contraceptive pills (OCP) act by inhibiting ovulation at the level of the pituitary and hypothalamus, via suppression of gonadotropin secretion. The estrogen component prevents the increase in follicle-stimulating hormone (FSH), thus inhibiting the formation of a dominant follicle."

So I doubt zoley will be strong enough for me.

Basically, I think k if I'd stayed on something all through my 40s it'd have been working. But because I'm trying to retrofit...it's never enough.

Thoughts on taking 2x cerazette versus zoley???

I don't think I ovulate much now anyway, it's something to stop the surge. The surge comes whether I ovulate or not. I was told in peri it goes for it then overshoots.

I suppose my question is, will 2x cerazette increase the strength of it's action in terms of keeping estrogen low and steady???

[joziel]

Two Cerazette (without any replacement E) will very likely cause low E symptoms and not be very nice. But you could add E back in separately.

[CrispyChick]

Right. So you think 2 will work stronger than 1 in teens of affect on E levels?

I just need stability. Don't give a stiff right now about low E symptoms. They are the least of my worries.

One did not hold my E last year.

It's just, from that extract it reads like you need the high E in a COC pill to fully supress. That's why I'm questioning it.

[joziel]

I think there are different modes of action. For eg, not all progestins stop ovarian function. The older ones like levonorgestrel often don't and work by producing cervical mucous which is inhospitable to sperm.

But the newer progestins like cerazette usually do stop it and I'd think that with the dose doubled, they definitely would.

By the way, I get migraines when my E peaks or gets suddenly high. I know because (TMI) it's accompanied by EWCM. But I can also get them when my E drops out. So hard to find something consistent and in the middle.

[CrispyChick]

Exactly!!! My fluctuations are killing me.

Last month - longest cycle ever. Low E symptoms. This month, so much EWCM  , first migraine in months and boobs like bullets which I never get!!! And it all makes me feel really really ill.

That's my problem. It's not the symptoms in themselves, it's the underlying illness. My poision.

So now I wavy to go d something to take these will fluctuations away. Geez, I'm even considering retrying chem meno - and start with hrt add back immediately this time. Yet I said it was the worst experience of my life! That's how desperate I am for it to all stop. 

[bombsh3ll]

150mcg of desogestrel is definitely suppressive if given long enough to work.

It shut me down at 41 and I have really high ovarian reserve.

[CrispyChick]

Thanks. That's useful.

How long do you think? I got to 7 weeks on one cerazette where my symptoms were off the scale and my E was 450 pmol. Previously, one cerazette would keep it in the low 200s.

I mean, the aim is not to kill my E off like cm, but I need it stabalising. So badly.

[bombsh3ll]

I would give it at least 6 weeks.

I stopped bleeding in less than that but that was when I had both a blood test and a scan.

Previously on 75mcg I had continued to have regular periods and after 3 months I had an estradiol level consistent with 12 weeks gestation, because I had developed a cyst.

After 6 weeks on 150mcg I had a follow up estradiol of around 100pmol/L and scan showed nice quiet ovaries with small inactive follicles only and no cyst.

I didn't suffer from any hypoestrogenic symptoms at that level but chose to go back on an estrogen containing pill for long term health reasons.

You also have the option to add transdermal estradiol to this rather than take a combined pill if you prefer or if you struggle to access a COCP due to age.

[CrispyChick]

That's very useful. Thank you.

Well, one step at a time. I'll try not to think about the future estrogen issue. Because I don't normally make progress with anything.

I shall await my next period, which, given the extreme high E symptoms this month, I suspect won't be too long, then go for 2x cerazette. 

[bombsh3ll]

Just to add there's no medical reason why you need to wait for a period, this simply comes from the idea of making sure you are not pregnant when you start a contraceptive.

[CrispyChick]

Yes. I get that.

It's just psychological. Last year when I tried one cerazette, I didn't wait for a period - and the whole event was a disaster!

So I'm waiting this time. I also want to do a blood test.

Also, given it's action, I can't see how it can work  on anything ahead of my next follicular phase. 

[CrispyChick]

Help.

Me again. Asy period draws ever nearer - I'm in two minds about what to try.

I'm wondering if anyone has any thoughts on what will be stronger to shut me down - zoley or the X2 desogestral?

It's not about low E for me at the moment. That said, 1x desogestral gave me foul pms before. Not so much when it wasn't suppressing - interesting. But I can add back later if need be.

So this is all about suppression. How quickly would zoley supress???

Supress and keep steady is what I'm looking for from this. I'm all too aware my pill trials last year made everything worse...

And then I read this article https://pubmed.ncbi.nlm.nih.gov/8629458/

And I now wonder if that's why I felt 20mcg coc pills not strong enough, compared to 30mcg about 3 years ago. But the 30mcg caused terrible migraines.

So, a further thought - does some estrogen in a pill encourage follicular growth? Over say no added E  And higher doses E supress it again. In which case, as I've been thinking, I'd be better with X2 Cerazette and no E. As I dont think zoley will be high E. Or does it continue down that you'd get even more follicular growth if you don't add in any E???

Anyone know the answer to that conundrum???

To anyone not familiar with my back story - I probably look like I'm way overthinking. But trust me, I'm in the depths of despair and trials nearly finish me off