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[CrispyChick]

Ok. I'm a very very complex case. So in a nutshell, my latest trials:

I am now deep in peri and cannot do nothing as I feel so ill I'd rather be dead. This, I believe is caused by severe peri fluctuations causing extreme central nervous system (CNS) dysfunction and immune responses.

So. The idea is shut down my system. Chemical menopause was tried last year. Far too brutal - caused the worst CNS reactions ever. As did the add back E. It was all far too much.

So. Recently tried 2x desogestral. I used to take desogestral and liked it enough. However, within 6 weeks this had supressed me almost as far as cm - my E level was 24 pmol. And, I knew I wouldnt tolerate a high dose of add back E. By this point I was suffering with lots of low E symptoms - achy joints, fatigue, low mood etc. I knew it well from cm.

So dropped down to 1.5 then one cerazette. I've now been on the normal one cerazette for 10 weeks. Unfortunately it triggered a cycle - which was hell. But I'm hoping it's now re supressing me to some degree. The bleed was 5 weeks ago.

Anyway, the upshot was, through all this, very little changed in terms of my low E symptoms. And, coupled with my CNS hell from all the changes and that breakthrough cycle - I couldn't continue like that.

So. Added in HRT. Started at 1/4 evorel conti patch. The idea was I'd comfortably add in E to double cerazette. But was too scared to go off piste and add it to one cerazette.

But here lies the conundrum. 3 weeks into that low HRT dose and I've been through hell. Not only my CNS carnage, but the additional E is triggering my histamine issues (MCAS) so it's not great. Not to mention I still feel so sore and achy from low E. So I know I need an increase.

But...I've had horrific mood swings since adding the HRT. I suspect it's the progestin in the conti patch.

Id like to increase one thing at a time. I'm on desogestral for goodness sake, surely a further 12.5mcg patch without added P will be ok? At least for the short term?

Because I'm using conti, I don't know what's causing what and because my situation is so complicated - I think I deserve to know what's what.

So I'd now like to increase E without any further P. I'll stick with
 the  original 1/4 conti though. 

Is there anyone who would support this? I mean, I don't really want to have to pay £300 just to be told I can try it for a month, but I just don't see the NHS supporting me here.

Any views on any of this? Cannot see the wood for the trees.

Or do I just suck up the moods and continue increasing with conti?

I'm a mess. I'm in constant low E pain. My CNS and MCAS stuff is hell, my mood swings are awful. But you know?! I think my hormonal fluctuations are a bit less. So I no longer want to die.

Progress...

I just need a little help with my next move. X

P.s or can I just buy Evorel 25mcg patches - and where from?

[bombsh3ll]

There are tons of websites where you can buy estrogen patches.

However an increasing number of specialists are willing to use 150mcg desogestrel as the progestin alongside transdermal estrogen.

150mcg desogestrel is also paired with 30mcg ETHINYLESTRADIOL in a combined pill FFS, so the idea that additional progestin is required for 1/4 of a 50mcg estradiol patch, which contains about as much estradiol as a first class stamp, is laughable.

What I would do if your GP thinks you need the combi patch as opposed to a plain estradiol patch, is ask for the sequi version. Regressive practitioners think all women love spending every 4th week bleeding, and you are clearly neither postmenopausal nor 55+, so their own guidelines recommend sequi rather than conti.

Each box will give you at least 4 plain 50mcg estradiol patches which you can use however you wish, and 4 combined patches, with which you can also do as you wish, and won't cost you anything.

[CrispyChick]

Oh. Great minds think alike bomb. I was just working all that out in my head.   

Sequi is a grand idea.

That said, events have overtaken and I've decided I need to increase that E now. I've only got conti at present, so I'm just going to go for it.

If, when I see GP next week, I'm having awful moods - I shall swap out then I think.

Thanks for looking. Love the postage stamp point. Lol. X

[sheila99]

I would swap the conti patches for oestrogen only with a separate progestogen, probably utro. That way you have all useable patches and you can decide whether or not to take the progestogen. You can try and online pharmacy, you could tell them the patches don't stay on so you're using more than your GP will prescribe.

[CrispyChick]

Ok. Thanks Sheila.

I can't take utrogestan. So it'd defo be agreeing just for the sake of it. 

I mean, I am open to doubling the Cerazette again if I can tolerate sufficient E. That's why I want to try this.

Right. I'm going to increase tonight. That gives me a good go at 1/2 combi patch before I see GP. Then take it from there.

[CrispyChick]

Any views on whether the extra progestin in the conti patch (increased to 1/2 patch last night) could actually help here?

By supporting the one cetazette in supressing my cycle? Because I know one cerazette is not really strong enough for me any more.

If I can take E in ok. I am open to going back to 2 Cerazette.

But, in the meantime, might the norethesterone help???

Anyone know?

[sheila99]

That depends if it's part of the problem or not. If it was me I would want to try oestrogen only to rule out norethisterone making things worse before increasing it. When I was on evorel sequi it wasn't enough to make any difference at all to my cycle which was forever out of sync but obviously that was without the cerazette.

[bombsh3ll]

I agree with Sheila, whilst desogestrel at 150mcg is well established at providing suppression in combined birth control, the combi patch for MHT is not designed to provide suppression.

Whether it does contribute a little, I don't know, but would not normally recommend doubling up on progestins because of the increased potential for toxicity, particularly in someone so sensitive.

Bear in mind that the 150mcg dose of desogestrel in the combined pill is designed to be adequate for all and really needs to be 100% for preventing pregnancy. There is always a margin. This is also seen with MHT where everyone is given the dose of progestogen that stops the highest risk women, with obesity, metabolic syndrome and a long history of anovulation, from getting endometrial cancer. Most would be fine (and feel better) with less.

Many women, particularly if slim and/or close to menopause would be adequately suppressed on less than 150mcg of desogestrel.

[CrispyChick]

Ok thanks.

So I'll stick with until I see my GP. Enormous bloating today - I expect from the patch progestin.

I'll attempt to find the dose of E that works on my low E symptoms. Then, if still having bloating and mood issues, might swap the combi patch for plain E patch at that dose and go up to 1.5 cerazette. I don't think I need 2.

I'm happy to pay for scans.

Not sure who is going to support me in this...so there might need to be some porkies. 

Just to add - Chat GPT says desogestral is a much more powerful ovulation suppressor (which is good for keeping my cycle flat) big norethesterone works better on keeping the endometrium thin. But also often 'feels' stronger in its side affect profile.

Righto. I have my next plan. Thanks gals. 

[bombsh3ll]

Desogestrel is also highly potent for endometrial suppression at the dose used, it has just never been widely adopted for commercial reasons as it was cheaper to produce combination HRT tablets with the older norethisterone. Women have historically not been considered intelligent or trustworthy enough to take their progestogen separately, and until recently were only offered the limited ranged of fixed dose combination products that existed, hence there is much more data available for norethisterone.

There are two studies from the mid 1990s showing endometrial protection with 150mcg desogestrel combined with 1-1.5mg oral estradiol - one of these (the 1.5mg estradiol one) used the desogestrel in a sequi regime i.e. only 14 days out of 28.

Additionally I have had regular pelvic scans since I was 31, most of those whilst taking Marvelon (150mcg desgestrel + 30mcg ethinylestradiol) and my endometrium made Kate Moss look like Kirstie Alley.

[CrispyChick]

  that's funny.

Well, I would rather stick on one cerazette and add in plain E. But that might well be a step too far even for my endometrium. Especially as it no longer supressed me so fully. 

I guess 1.5 it is.

But still, if I plod on just now, I'm moving ever closer to finding my E dose.

I only need dodging E because the Cerazette is giving me low E synptoms. 🙈

[sheila99]

Another option would be to stick to 1 but have a scan in a few months to see if it's enough. Newson are pretty good at letting you experiment if you can't get what you need from your GP though obviously it costs.

[CrispyChick]

Ok. So I've ordered evorel 25s.

I'm thinking it is best to try E and P separately for me.

If I now swap to just E patch. Do you think stopping the norethesterone will bring a bleed??? Yet more change. 

[bombsh3ll]

I don't think so if you remain on the desogestrel.

You have only been on a fraction of a dose anyway.

I agree you are much better trialling estradiol without adding an extra unnecessary progestin.

[CrispyChick]

Should I go straight up to 1.5 cerazette? Or stick on one for the time being and see if I tolerate the E?