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[mcwey]

Ladies,

Recently been to my gynae as have premature menopause. After reviewing all my bloods/ultrasound etc and completed a full meno exam she has told me my oestrogen levels at 19 were that of an 85 year old, I am 45 . After much discussion she has advised that in premature meno you need aggressive oestrogen replacement quickly. Rather than being on femoston 2/10 she has said oestrogen gel and the mirena will be much better for me and my vaginal atrophy which has been my main issue will resolve itself quite quickly she also gave me BV which will is like a facial for your bits which made me die laughing.

My question is has anyone else moved over from 2/10 to estrogel and mirena and if so how did you find it?

I am so relieved to at last been to an amazing gynae after 6 months of uti's, and 4 years of just feeling like crap.

[Dancinggirl]

mcwey - welcome to MM - I had a premature meno so I'm pleased to hear you are getting some good advice.
If you are happy with Femoston 2/10 then I would stick with this but maybe add some local oestrogen like Vagifem a couple of times a weeks to help with the VA. If you are fed up with having a monthly bleed then the Mirena is a good option as you can then add as much oestrogen as you like - depending on how you feel.
I've been on and off HRT since my 30s, I'm now 59, and have tried just about everything going.  I did have a Mirena for 4 years in my mid 50s and used Oestrogel for the oestrogen bit.  I did find it made me feel a bit sedated for the first few months but probably because I am very sensitive to progesterone - most women seem to do really well with the Mirena because it tends to stop all bleeds after the first few weeks.
Did the gynae say why she wanted the change in delivery of HRT? You are already on a medium dose HRT which should give you the protection you need for bones and heart.
I get horrid burning and soreness with UTi type symptoms without any infection present and use Vagifem together with Oestrogel and Utrogestan as my HRT regime. I also use a little Multi Gyn Actigel everyday to help keep everything comfortable and healthy around my vaginal area. Keep posting DG x

[Hurdity]

Hi mcwey

I don't have direct experience of either product but I was wondering what your symptoms are that means you need to or would benefit from increasing your oestrogen dose?  If you do decide to increase then I can see that Mirena and gel could be the way to go - because with tablet HRT you are having to metabloise a lot of oestrogen/progestogen (through the liver) to get enough in your system, whereas transdermal oestrogen delivers straight to the blood stream.

Hurdity x

[mcwey]

Hi Dancing Girl and Hardily,

I have found out today that my oestrogen level has stabilised to a normal range from 10 weeks on Femoston 2/10 which is good news and probably the reason why I am feeling better in myself again. However, that said I am on the second two weeks, the progesterone bit and woke up today to burning and stinging yet again.

 It would seem that when I have the progesterone side of HRT it makes the old symptoms return. I think the gynae's reason for changing me over to mirena/estrogel is because the femoston is not taking away my symptoms all of the time just the two weeks of the oestrogen.

Dancing girl did you find the years you were on the mirena/oestrogel good? We seem to have the same issue really. How long have you taken HRT in total. I was under the impression that I could stop it all at 52 and the symptoms would no longer be a problem but am I naive in thinking that?

 The burning/stinging/uti's are such a nuisance to live with. Also did you struggle with mirena/oestrogel side effects in the beginning? How long did it take for that course of treatment to settle down and did you have side effects from both?

Many thanks

Thank  you for all your help. 

[Hurdity]

Hi mcwey - Hurdity's the name  !!

I have read that progesterone and progestogens can interefere with oestrogen receptors elsewhere than the uterus - so that oestrogen is less effective and symptoms can re-appear - but I don't know much about this in detail. It does sound as though this could be happening with you?

Re stopping HRT - some women do stop full HRT after some years, but there is no need to if you have no risk factors and are happy with it - if you look at the risks and benefits on this site you will see that up until the age of 60 the benefits are thought to outweigh the risks, and between 60 and 70 they are roughly the same:
http://www.menopausematters.co.uk/balance.php

As for vaginal atrophy - treatment for this is for ever - so this could be just local oestrogen or full HRT or the two combined. if you stop everything then VA and associated symptoms will recur.

Because you are only 45 you are well below the average age of menopause of 51-52 - but you don't need to stop HRT when you reach this age - it's just when the (low) risks begin to start. At the moment you are only replacing what your body should be producing naturally.

Hurdity x

[Briony]

Does anyone know roughly how gel doses equate with pill doses? (I know a direct comparison is impossible, but just roughly). If you were on  3mg estrogen in tablet form, what would the equivalent in gel (or even patches) be? Would the higher gel/patch dose be enough to suppress ovulation like the BCP does? I am about to move up to a 3mg BCP but am slightly uneasy with the fact this goes through the liver, like you say. Especially if I am to take it for another decade. If I could get the equivalent dose in a different format, I guess that would be safer? (I'm a fairly high risk for BCP - migraines with aura in my 20s and early stoke on one side of family). So many people seem to have had good results with the gel ? Really interested to know.
 - Thanks,x

[Poppyflower]

Hi Briony this is taken from Professor John Studds website:

Suppression of ovulation by transdermal estradiol in the form of estradiol patch 200 mcgs twice weekly has been shown to be effective9 and transdermal estrogen in the form of estradiol gels, Oestrogel 2 measures daily or Sandrena 2.grams per day will also be effective. It is necessary to give cyclical progestogen by some route to prevent endometrial hyperplasia but it is common for the PMS symptoms to reoccur during these days, hence a minimum duration of progestogen is recommended for the first seven days of each calendar month with a withdrawal bleeding occurring on about day ten of each calendar month. Alternatively a Mirena IUS is usually very effective although perhaps 10% of women do have absorption of the d norgestrol and suffer almost continuous PMS symptoms 10. These symptoms disappear within twenty four hours of the removal of the Mirena IUS

[GypsyRoseLee]

That's interesting what Studd says about the Mirena. I tried one about 9 years ago and hated it. I suffered with permanent PMS, gained weight and had spots for the first time in my life.

This went in for 7 months because my GP refused to believe the progesterone was causing the problems. I finally had it removed at a FPC and within a day I felt so much better.

[Briony]

Thanks PoppyFlower. V interesting. Have never heard of anyone on 200mcg twice weekly. Seems v high? 

[Briony]

That's interesting what Studd says about the Mirena. I tried one about 9 years ago and hated it. I suffered with permanent PMS, gained weight and had spots for the first time in my life.

This went in for 7 months because my GP refused to believe the progesterone was causing the problems. I finally had it removed at a FPC and within a day I felt so much better.

It has Levonorgestrel in it, which does affect some. Made my SIL come out in spots, made other friends depressed, yet lots of others love it.

[Poppyflower]

200 mcg does seem high but I think that if you are to use estrogen rather than progesterone to "shut down" the ovaries, those high doses are needed. If you are using mainly the progesterone like in the Mirena or other BCP then it is less or no estrogen?  The 200 mcg recommendations are for progesterone intolerant or progesterone withdrawal intolerant women who cannot use birth control pills to do the job (due to too much progesterone) Does this make sense? Sometime I am writing things and it seems like in my head it is clear, I post and it is like what have I just written??? : Also in regular birth control pills the amount of estrogen is quite high although synthetic and likely that is the dosing equivalency. I would think though that the 200 mcg would be better for us and extra bonus that it is the patch form. Now I am pondering.....but if when we take regular birth control pill which has both estrogen and progeste a in it....why do they tell us we cannot take a continuous form of HRT unless we are menopausal? Is it due to causing irregular bleeding?

[Briony]

200 mcg does seem high but I think that if you are to use estrogen rather than progesterone to "shut down" the ovaries, those high doses are needed. If you are using mainly the progesterone like in the Mirena or other BCP then it is less or no estrogen?  The 200 mcg recommendations are for progesterone intolerant or progesterone withdrawal intolerant women who cannot use birth control pills to do the job (due to too much progesterone) Does this make sense? Sometime I am writing things and it seems like in my head it is clear, I post and it is like what have I just written??? : Also in regular birth control pills the amount of estrogen is quite high although synthetic and likely that is the dosing equivalency. I would think though that the 200 mcg would be better for us and extra bonus that it is the patch form. Now I am pondering.....but if when we take regular birth control pill which has both estrogen and progeste a in it....why do they tell us we cannot take a continuous form of HRT unless we are menopausal? Is it due to causing irregular bleeding?

Couldnt agree more! I literally begged to take 100mg Utrogestan continuously but was told I couldn't. However, she was fine with me taking a BCP back to back 

[Dancinggirl]

mcwey - we seem to have pulled way from your original questions.  You asked whether the burning would stop when you stopped all HRt - I'm afraid this is highly unlikely as UTI symptoms and VA can actually get worse without full HRT.  I'm now 59 and using full systemic HRT with Vagifme once a week to help keep things really comfortable around my lady parts.  I did try local oestrogen alone but it wasn't enough to keep the burning at bay.  I have to say that progesterone doesn't actually trigger the burning for me but as progesterone can suppress some oestrogen (as Hurdity explained) this might be an issue fro you and I would suggest that adding some local oestrogen like Vagifem might worth you trying. Dg x