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[mzh140]

Hi hi, popping back here with a question after receiving some really valuable information from you all a little white back. I'm 50, childfree, with a history of diagnosed adeno and suspected endo. At 45 I began experiencing peri symptoms (hot flashes, non-aura migraines, frequent yeast infections) along with increasingly bad endo symptoms including hemorrhagic cysts, melena, bladder pain etc. As I have not had children and endo was a strong possibility the coil was ruled out and I was put on the COP (Rigevedon) which was brilliant, got rid of all the adeno/endo symptoms and, for ages, controlled the peri stuff too. At 49 I started getting breakthrough peri symptoms (vaginal dryness, migraines again, loss of orgasm) and earlier this year, now 50, I transitioned to continuous HRT: two pumps of oestrogel and one utrogestan a day (the continuous regime is recommended for controlling endo, and it wasn't clear if I still had a cycle).

Two months later and turns out I DO still have a cycle running under the HRT, which I do not want to have. I received some great advice on here, thanks to which I have been prescribed desogestrel to take as well as the HRT. This is fine. However, what I don't clearly understand, despite asking the doctor the question several times and also Googling it, is why I need to take the utrogestan AS WELL. Surely I could just take the desogestrel and the oestrogen? My friend who has a Mirena coil only takes supplemental oestrogen, she doesn't have extra micronised progesterone too. I get it that the desogestrel will (hopefully) suppress my cycle and is necessary to have with the oestrogen, but what is the role of the utrogestan in this regime?

Thank you so much in advance for any clarity on this, I really appreciate it!

[bombsh3ll]

There are no studies showing the 75mcg dose of desogestrel provides adequate endometrial protection.

Whilst it almost certainly does, at least with a low dose of estrogen - in fact 150mcg has been used sequentially which would equate to 75mcg continuously - current guidelines recommend against using the POP at a single dose for endometrial protection.

The mirena IUS is well studied and licenced for this indication, that's the difference.

An increasing number of specialists are willing to use a double dose of desogestrel i.e. 150mcg taken continuously as endometrial protection based on the existing evidence (2 fairly small studies from the 1990s, plus the fact 150mcg desogestrel is commonly paired with 30mcg ethinylestradiol in a combined pill) This is off licence though and your GP may not agree.

However you can buy desogestrel from online pharmacies up to the age of 55 if you say it is for contraception.

[mzh140]

Hi bombsh3ll, thank you so much – so keeping on with the continuous utrogestan presumably means I will have enough endometrial protection to go with the oestrogel. Got it, thank you. I wish my GP could have explained it that clearly.

I'm just starting a bleed so will get that over with and then add in the desogestrel and see what happens. I was considering taking a break from the utrogestan to allow the bleed to happen, but I suspect it'll just mess things up even more.