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[Pollie]

Morning ladies

Background: taken off HRT 7/8 weeks ago due to investigations for post menopausal bleeding. All ok, mirena fitted 11 days ago and Gyne wants me to go without Hrt for another month to make sure no more bleeding occurs.

Now very very sore down below so thought I'd try Vagifem that I had been prescribed 6 weeks ago (didn't think I needed it at the time and wondered why I was given it lol - clearly my Gyne knew what was coming)

Taken two tablets only and then stopped as on 3rd 4th and 5th days I have had  heavy spotting.

So my question is this - could it be the Vagifem or is it too soon to have this side effect ? Would a gel be better for me ?

Pollie

[Taz2]

Hi Pollie - personally I think that it would be unlikely that the Vagifem has caused the spotting after only using two of the pessaries. When did the gynae tell you to begin the Vagifem treatment? Did he want you to also wait another month before beginning it as it is a form of HRT?  Spotting or strange bleeding patterns are a one in ten side effect of the Mirena and take a while to settle down but I'm not sure how that works if you are post menopausal.  How long has it been since you became post menopausal?

I sympathise totally about the soreness!

Taz x 

[Pollie]

Hi taz

Gyne offered me Vagifem after first consultation but before results of biopsies and blood tests were back. Maybe she could tell from looking ?  I thought it was odd at the time but she said that va can sometimes cause bleeding .... My bleeding was the period from hell so I thought not caused by va but took the prescription (as you do  ) and  did nothing with it til now.

Bleeding has apparently been caused by a 'proliferative endometrium which is unusual in post menopause'

This is my 3rd mirena and previously had spotting for a day or two after insertion then nothing more.

LMP was May 2013 but had mirena at that time so may not be accurate date however recent blood test reveal definite post menopause and oestradiol of 19 p/mol 

I asked to go back on full hrt and Gyne said "wait a month for mirena to settle and I want to be sure you have no more bleeding.." She doesn't know I am now trying Vagifem as I only decided a few days ago.

Just so fed up and weepy with the whole business.

Conversely the weeks leading up to the bleed I was really really well; sleeping through the night for the First time in 9 years,  not peeing so much during the day, plantar fasciitis miraculously gone after 4 years, calf, thigh and arm muscles not stiff, finger joints not sore anymore etc etc.  all things that I had been to doctor with but not had linked to menopause  

Pollie

[Dancinggirl]

Hi Pollie - You don't say how old you are? If your endometrium has built up then my understanding is that proliferative bleeding is likely to follow. Though you have recently had a new Mirena fitted, if you lining has been quite thick, then the Mirena will cause your lining to shed efficiently so some bleeding in the first few weeks and some spotting there after for up to 6 months is quite normal. It sounds sensible to go without any additional oestrogen for the initial month to allow for the womb lining to shed.  Sadly being on HRT doesn't always stop all VA so many of us need local oestrogen like Vagifem alongside full systemic HRT.  When I first started using Vagifem (I had a Mirena at the time) I got some spotting and cramps and I think if you read the leaflet this is quite a common side effect.
Do try using some vaginal moisturiser as well to ease discomfort but I should think it would be fine to continue with the Vagifem which should help the VA.  It would probably be wise to check with your gynae about all this as well.
I must say that the Vagifem won't be enough oestrogen alongside the Mirena to stop flushes and other meno symptoms  - I think you will need some Oestrogel as well but I think your gynae wants your lining to get thinner before adding some systemic oestrogen. DG x

[Pollie]

Hi DG thanks for response

I am 52. My lining was, according to Gyne, very thin at first hysteroscopy a few weeks ago and non existent when she did second hysteroscopy and put in mirena 10 days ago....

My oestrogen is rock bottom as of blood test last week so I am not sure it is a build up of lining.

Gyne is away on holiday but I have left a message for someone to call with advice as to whether to continue or not.

I guess it could possibly be bleeding from VA as I have had no hrt for 7 weeks now. Can VA happen that quickly ?

Pollie

[Dancinggirl]

Pollie - VA may have been happening for a while but symptoms are only emerging more now - it often hits us quite suddenly. Were you on HRT already before the problematic bleeding started? If I were you I'd be using the Vagifem as instructed as the Mirena will be keeping the womb lining thin so it is unlikely that the bleeding is something sinister. I would definitely use some Oestrogel or an oestrogen patch alongside the Mirena as I find this really helps with VA.  I've used vaginal moisturisers for many years - I use Multi Gyn Actigel  - as I find it helps to keep things lubricated and healthy.  DG x

[Pollie]

Just heard back from Gyne, actually, phone call from health care assistant - so for anyone following this thread ;

They suspect the spotting is From VA due to complete withdrawal of HRT 7 weeks ago, rather than sinister post menopausal bleeding for which I am being investigated.

They have recommended I continue with Vagifem for 12 days and if still bleeding to contact them for further advice.

I used Vagifem 6 hours ago and already everything feels better ! I know this could be placebo effect but I really don't feel so sore now. Mild tummy cramps but skin feels comfortable 

Everyone knocks NHS, and I don't have a 'menopause clinic' that I can attend but my local hysteroscopy clinic who have dealt with my 2 week referral at the hospital have been so good to me I will write and say thankyou. I am so grateful for their care and expertise.

Pollie

[Dancinggirl]

Sounds good Pollie - hopefully the Vagifem will help but I'd still ask fro the extra systemic oestrogen. DG x

[Pollie]

Sounds good Pollie - hopefully the Vagifem will help but I'd still ask fro the extra systemic oestrogen. DG x

I would have it now, right this instant, but been told I have to wait a month !!

[Hurdity]

Hi Pollie

I am a bit confused to be honest.

What HRT were you on when you had the bleeding which is being investigated and are you definitely post-menopausal? Interesting that they do define bleeding when on HRT as post-menopausal bleeding - which is not nearly as worrying as PM bleeding when you are not on HRT. The bleeding which you said was the period from hell would not be from VA. Also I am confused as to why you have a proliferative endometrium (which you might expect on HRT - but depends which type you were on and whether you were post-menopausal) when the endometrium is very thin and your oestrogen levels were that low!

I presume they did the hysteroscopy after the bleed which would explain why it was thin, because the lining was shed? Also low oestrogen levels would usually follow a bleed.

Yes you're right your LMP date is irrelevant when on the Mirena because they often stop periods - so has no bearing on whether you arre menopausal or not!

If your lining is that thin I agree that oestrogen replacement should happen asap because if you are post-menopausal you could get an atrophied endometrium and this can cause bleeding - but probably not in the space of a month.

I have a feeling we might have discussed this before?

The main thing is to know why you had the period and to check if anything wrong - eg fibroid or polyp perhaps which could cause bleeding even though lining is generally thin?

Sorry if this sounds confused as just thinking aloud!

Hurdity x

[Pollie]

Hi Hurdity

I am a bit confused to be honest too lol 

In a nutshell - all dates approximate due to meno brain ;

2nd mirena fitted 2010 periods continued as normal

Last period Feb 2012

Oestrogen only patch May 2013 due to disrupted sleep/overheating.

Mirena removed Dec 2014 and oestrogen and progesterone patch started

June/July 2015 three heavy period like bleeds

June ultrasound shows 11mm  thickened lining

End july hysteroscopy and biopsies taken at end of period - Gyne said lining thin. Biopsy results 'proliferative endometrium unusual in post menopause' so stopped taking HRT as still bleeding

August Blood test confirms post menopause -  v high FSH high LH and very low oestrogen.

September-  2nd hysteroscopy lining non existent. Biopsies taken waiting results. Mirena fitted. Told to wait 1 month before starting hrt - just to make sure bleeding stopped.

10 days after Mirena fitted started Vagifem as very sore. Took Vagifem for two days and started spotting again....

On advice of Gyne have today started Vagifem again and will continue for 10 days despite spotting. If still bleeding after 10 days need to stop and contact Gyne again.

I think I am post menopause. I wonder if I did not absorb progesterone well from patch hence lining build up 

Anyway nothing sinister - just confusing and inconvenient but I will be ok shortly

Pollie

[Hurdity]

Thanks for this Pollie!

As I said before it's difficult to tell what your periods would have been doing as you had a Mirena.

From what you say to me it sounds like the heavy bleeding you had were proper periods - maybe you were in late peri-menopause and would have had a couple of bleeds anyway - and especially as the results showed you had proliferative endometrium which is then thin.

What was the patch you used? The progestogen dose would not usually be sufficient to stop heavy periods so to me that sounds like the explanation - not that you weren't absorbing it - but that you still had a bit of a cycle. However I am not the expert!!

The date of menopause cannot be decided until 12 months following the last period so of course you won't know this even if the bleeds were proper periods. You could well be post-menopausal now!

This is what it says on this site about FSH levels ( although oestrogen is notmentioned):

A normal level does not exclude early menopausal transition and a raised level does not exclude continuing ovarian function. One raised level should therefore not be relied upon as a reason to stop using contraception since egg release can still occur late in the menopausal transition.

http://www.menopausematters.co.uk/diagnose.php

I can imagine if this is the case (you are now post-menopause) you would be unlikely to have a bleed on the Mirena. Hope the biopsies show everything is OK - but even if you have a fibroid the Mirena will ensure this does not grow while taking oestrogen.

Hopefully you can restart HRT as soon as possible! I expect you are counting down the days!

Hurdity x