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[bombsh3ll]

That's a good thought, I took think about what progestogen will suit me best when I graduate from OCP to hormone therapy, and both dydrogesterone and dienogest are on my shortlist.

I'm lucky enough to be breast free due to my family history but still keen to minimise the long term progestogen burden for cardiometabolic, cognitive and quality of life reasons.

[Konijntje]

I tried dydrogesterone (duphaston) last year, but maybe too short of a time. It made me very anxious, it felt similar to levonorgestrel (I tried microgynon 30 some years ago) for me. But I’m very sensitive to progestins and since dydrogesterone is first choice here in the guidelines, I know plenty of people that do well on it. (My neighbour has been on femoston for almost 15 years, her GP (same as mine) advices her to stop every few years, but she just says no and continues to take them  ).

[Konijntje]

3 weeks (+1 day). Almost finished with the active pills. Last week was very rough, on Friday, my lower back pain was through the roof and I thought that I was either going to have a bleed or my lower back pain just kept building up like on progesterone. However, it was neither of the 2. Still no blood and I still have the pain, but it is a bit lighter again.
So, I am going to take the placebos this first month to force a bleed, since I’m hoping the cramping will get less afterwards.

Headache and neck pain is still there, but definitely slightly less. Thirst/dry mouth/dry skin isn’t getting less and is driving me kind of crazy. I did order some products to stimulate saliva production, hopefully that will at least help with the dry mouth. I’m very moody, but I’m not sure if it is the pain (haven’t been working out either) and dry mouth or the drospirenone.

I still have the occasional hot flush or night sweat, but I think less than the second week, so the estetrol might turn out to be just the right dose or just slightly too low.

I’m still planning to take the Drovelis until my appointment, as I read everywhere it takes a few months for mood to settle, but I’m pretty sure I’m going to ask to switch to qlaira then if the dry mouth continues. The dry skin is also a problem, because my hands are already pretty bad (bleeding knuckles) despite using creme, usually that is only a thing in winter when it’s cold. I wasn’t expecting this side effect being so bad for me, but I’m happy to know, so I can also take Slynd of my list of options if it doesn’t get less.

[Konijntje]

I’m now 2 days in on the placebo’s and started very light spotting. I still feel like my lining needs to be shed, although it could be very thin from the tibolone and now Drovelis and the severe cramping could be just a side effect. Who knows?

Anyway, if the bleed isn’t any heavier tonight, I don’t want to start a new pack yet, but I do want to take estrogen (I have estradiol tablets), because I’m experiencing hotflushes and night sweats (I think the estrogen is too low in Drovelis, I was still having the occasional hot flush and night sweats on the active pills, so it was to be expected that those symptoms would reoccur fast on placebo). Would taking just estrogen stop my bleed (I don’t want that)? If it would, I guess I’m settling for nothing another day.

I’m really hoping things will get better on my next pack, because this month has been rough.

[bombsh3ll]

I would absolutely take either the estradiol tablets or at least start the next active pill pack rather than suffering.

Anyone who can make a prediction about your bleed in this situation is probably off spending their lottery winnings, however there's no medical advantage to withdrawal bleeding on birth control pills.

It is a relic from a very paternalistic era in women's health care built in for no other reason than so we wouldn't think we were pregnant, being such untintelligent creatures that we couldn't understand amenorrhea as a side effect.

[Konijntje]

Yes, I understand about the bleed not being neccessary and am planning to skip the placebo’s on the next months. It’s just that I’ve been having cramps for the last 6 weeks (the last 2 weeks of tibolone and the whole pack of Drovelis) and I’m just hoping a bleed might help (sort of a reset). Maybe I should have waited before starting Drovelis when I stopped the tibolone, because now I don’t really know if it a drospirenone side effect or my body just still trying to bleed (and the drospirenone might be suppressing that, as it’s supposed to do). I’m probably overthinking, but since I’m getting side effects from everything I’m trying and have a horendous cycle at this point, I’m second guessing everything.

I think I’m going to take estradiol tonight (is 1 or 2 mg a medium dose? My tablets are 1 mg I think) and start the new pack tomorrow, besides the spotting this morning, I haven’t seen any more blood. Still have cramps though.

[bombsh3ll]

I'd probably take the 2mg if you are symptomatic.

There's 1.5mg in Zoely but I have high ovarian reserve and even shut down I have some endogenous estradiol release.

[Konijntje]

I did sleep better after taking 2 mg of estradiol (no night sweats and no hot flushes this morning), but pretty nauseous today. I have been taking estetrol instead of estradiol in Drovelis and while it is a bit too low of a dose, I do like that I don’t get any nausea at all from it. With estradiol, it takes a few weeks for the nausea to subside (doesn’t matter if it is oral or transdermal), when I first started, I had to start really low because of that.

So, still no bleeding other than maybe very light spotting, so I’ll just start my new pack tonight. I’m just going to treat the cramping as a side effect from Drovelis (which is reported often in the first month) and not as a sign that I have a thick lining that needs to be shed (because that would have happened by now I think).

I’ll update again once I have new things to report.

[bombsh3ll]

If you can afford it you could always book a private ultrasound to check your lining for peace of mind.

I have one regularly for ovarian screening.

[Konijntje]

I’m in the Netherlands, so things work a bit different. I am planning to ask for a physical, because things don’t feel completely right in my vagina. My GP said I don’t have a prolapse, but I have doubts. At the specialist, I’ve had 1 appointment at the clinic, but didn’t think to discuss it then (they only checked my blood pressure) and my next appointment will be by phone, so I’ll ask for the next appointment to be at the clinic then. I could ask for an ultrasound too probably.

I’m not really worried about a thickened lining, because I have had a bleed 1 week into the tibolone, which was similar to a (for me) light period, which would probably be a normal-heavy period for a lot of others (mine are usually very heavy). I was just hoping the whole cramping would subside after a bleed. I did read many more reports on a lot of cramping the first month on Drovelis and for most this did seem to resolve somewhere during the second pack, so fingers crossed it’s the same for me.

[Konijntje]

Small update: For the last few days I’ve been supplementing with estradiol (1 mg tablets), because the estetrol dose in Drovelis is obviously too low for me. Or maybe the estetrol is just not working well for me, I’m not sure without comparison or a way to up that specific dose.

I’m nauseous, which is a temporary side effect from estradiol (both oral and transdermal) for me, so that will probably subside in 2 weeks. (Estetrol doesn’t make me nauseous at all, which was a big plus). I’m having less hot flushes and sleeping slightly better, hopefully this will get better after longer. My dizziness is not gone, but I think it is a bit better. My dry mouth has improved considerily, so besides the diuretic effect from drospirenone, it was probably caused partly by low estrogen. It’s not gone, but tolerable now, I wanted to know if drospirenone could work for me as a progestin, because Slynd/Slinda with estrogen is another option. My back pain also might have improved slightly, but still pretty bad, so still not sure if that is caused by the progestin or low estrogen or something else.

So, I think my adding estrogen experiment is working well, although I’m still not feeling great. Drospirenone might turn out to be an option for me. I still think I’ll probably ask to try qlaira first, before considering Slinda/Slynd (I think it’s called Slinda in EU and Slynd in UK?) with estrogen, because I do find the diuretic effect very annoying, so I’m hoping dienogest might work better for me. I’d still prefer to not to have to take a progestin at all, so I might look into getting Duavive abroad at some point. It is still available in Belgium, but I’m not sure if I could get it there, how that works with getting prescriptions and so on.