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[Sonjan]

Hi there
I am 45 and have severe endometriosis. Therefore I started taking the cerelle mini pill for the last 3 years to stop my period. I have struggled with the pill digestion wise but have cut out gluten and followed a low fodmap diet for this. Later last year I was told that I was peri menopausal and I started taking Lenzetto spray and was told to double my pill: I really really want to stop taking the pill as it’s causing lots of issues. I was wondering what else I could use to stop my periods as well as taking enough progesterone alongside HRT? I have tried to have the mirena coil inserted but a surgeon couldn’t do it.
Thanks in advance

[Floradora]

Hi Sonjan. I too had severe endometriosis and in my early 40’s I took Provera (medroxyprogesterone acetate) and this was the only thing that allowed me to live a tolerable life, kept the tissues  reasonably thin and the bleeding and pain under control. You could use Provera as the progestogen part of your HRT and that might help. You will have to be careful that you keep your estrogen dosage reasonably low so as not to exacerbate the endometriosis if you have any active/residual deposits x

[joziel]

Hi Sonjan - if you read the recent posts in this forum, you'll see a detailed one from me about my experience with Cerazette (same as Cerelle - desogestrel), endo and HRT. I'm 44yo and peri, with mild endo. (Laparoscopy in 2013.)

The info you've been given is incorrect: Desogestrel/Cerelle/Cerazette is not acceptable as the progesterone part of HRT - even when doubled. There is no research to show that it offers protection of the endometrium during HRT. You can continue to take it (at the usual dose) alongside HRT. Adding in estrogen and another progesterone. Like utrogestan, for eg.

I totally get you hating the desogestrel. I also hated it, which is why I tried to stop it despite some doctors advising to continue. What are your digestion struggles with it? I tend to get constipated on progesterones and am also finding utrogestan the same unfortunately.

I stopped Cerazette/Cerelle when I started HRT (with utrogestan 100mg on a continuous basis). Everything was okay at first and then my ovaries woke up. I now have some of the old familiar endo twinges and pains I used to get. But, as long as I don't bleed and get the pain during my period (the "I'm going to pass out, throw up, get runny poo and pour sweat" kinda pain), I can cope with the much milder pains during the rest of my cycle. (As long as I don't worry about what they are and freak myself out.)

So I'm sort of in a holding pattern at the moment and not really sure what I'm doing. I'm going to get bloods done this coming week I hope, and will see what my estrogen levels are. If I need more estrogen I probably need to go back on Cerazette or change something with the progesterone - or I worry I will make endo worse.

What you might want to investigate, is a continuous HRT which uses one of the other progesterones that have also been used to suppress endo - Evorel Conti patches have norethisterone, for eg. They are only a 50 estrogen dose though, but you could add a separate Evorel patch of 25/50 or whatever, if you needed more. If you needed more norethisterone to suppress the endo, you could take the mini pill orally (Noriday) which is norethisterone 350mcg. Whatever you try though, be sure to go onto continuous HRT (not sequential) - as endo folks should always be on continuous, even if they are peri - to suppress the endo. These are the ideas I'm thinking about at the moment. I am also hopeful that taking the progesterone transdermally in a patch rather than orally, will help reduce the gut effects and the constipation I have.

Lastly, constipation and wind can also be caused by low estrogen. So you might want to check what your estrogen levels are, they should be 200nmol or more and you should be symptom-free. If you then want to increase your estrogen, you might want to try that first before stopping the Cerelle - because maybe it will get better....