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[Ljp]

Hi all,
Feeling a bit bewildered and confused, here's my story. I'm 51. Last period August 2014, overactive bladder, frequent urination with urgency, hot flushes (mostly night time), severe anxiety at times, mood swings etc etc.
Started using estriol 0.05% in May, two weeks daily, then twice weekly since, to help with urination and va symptoms.
I had a full abdominal and internal vaginal/uterus scan in August to investigate pain in right side (turned out to be muscular) nothing abnormal found, other than a 1cm fibroid, and a nabothian cyst.
Then end of October, I woke one morning to discover a bleed, not flooding or overly heavy, brownish blood, lasted about 4 days. I did the right thing, called my GP she wasn't  over,y concerned as scan was only two months previous, but referred me to see gynae at hospital for a hysteroscopy.

Just has appointment today, not pleasant, very uncomfortable at times, also my cervix was closed so she had to open that first.
She said all looked good and normal, took a small biopsy, but not much lining so not easy ( and it hurt!)… then spoke about estriol cream, she said it could be that the cream is having an effect on the uterine lining and that could have caused the bleed. She also said that estriol cream is considered safe to use unopposed by progesterone for up to two years. But it could well be that, which caused the bleed.

My options were, continue as normal, see if it happens again, be prepared for another bleed and possible hysteroscopy.
Or as she suggested, have mirena coil fitted to protect uterus lining, and provide progesterone, so I can continue  with estriol cream, or estring, and even try patches if I should decide to in future, as the coil provides the opposing progesterone.

She was very nice, and understanding, I was able to go and have a coffee at with my husband for an hour, to try balance my choices.

I went back an hour later and decided to have the coil fitted and also an estring, as my most troublesome symptoms are definitely bladder related.
As she explained, nothing is written in concrete, I can try the estring (lasts for three months) then see if I want to continue with that or try a patch.

I figure if I don't try, I won't know if I can feel better with the help of HRT albeit localised at present.
I did ask if the estring can help at all with hot flushes, she said, so en women say it does, but it's not as effective as a patch.

Sat relaxing with a wheat pack at the moment, as feeling a bit uncomfortable, from all the interference, she did say it might be cramps for a couple of days ish.

Anyone with any experiences to share of mirena coil, estring, patches? Any combination? 😊

Thank you for taking time to read

Lisa 

[Dancinggirl]

Hi and welcome to MM lisajp
The bleeds could be you own hormones having a final gasp???!!! Have they tested your hormone levels - if so, what were the levels?
It is common to get vaginal atrophy and bladder problems with the meno.  I really wouldn't have a Mirena if you are just going to use local oestrogen - even the Estring. I found that local oestrogen gave me a bit of spotting to start with so as you have had a full investigation now I would try just the Estring on it's own and see how it goes.  If you are post meno the Mirena will give you far too much progesterone which could cause the womb lining to thin too much without enough oestrogen to balance this out - the gynae should know this!!!!
If however you do have other meno symptoms, like flushes, you want to control then do have the Mirena fitted and use some stronger systemic oestrogen as either patch or Oestrogel (which are both transdermal) as this may be more effective in helping your bladder issues.  I have tried all the local oestrogen treatments including the Estring - the Estring was the best but you have to be careful to use vaginal gels like Multi Gyn Actigel to help prevent thrush or BV from taking hold.  I'm 59 now and back on full systemic HRT as this has still been the best way to help my VA and bladder issues.  BTW - VA and bladder issues don't go away and most women need at least local oestrogen for the rest of their lives to help reduce these problems - the 2 year cut off is a nonsense - again the gynae should have known this.
Hopefully others will be along with advice as well.  DG x

[Ljp]

Thank you for your reply dancinggirl, I am worried now that the coil might cause more problems than it solves, have I been too hasty? Should I have just continued just using the estriol?
I was concerned the bleed could happen again, and really don't want to keep having hysteroscopy done.
I also felt that by having the mirena, if I choose to try patches, as night flushes are bad at times, and mood swings, then the coil provides the progesterone.
Not had hormone levels checked no.

Oh blimey I hate all this, how to choose what to do and what not to do , now feeling worried by my choice to have coil fitted

[Hurdity]

Hi Lisajp

I agree with Dancinggirl's post and advice. Also I'm not quite clear whether you have actually had the coil fitted or not, or just agreed to have it later? If so then if the other symptoms are troubling you too, then it's fine to have it fitted but I would definitely have some oestrogen (patch or gel) along with it which will help enormously - and also will help re the VA symptoms ( bladder and vaginal).

Yes you are also fine to continue with the estriol - it is not necessary to have Mirena to protect the womb from estriol cream. It is a very weak oestrogen and progestogen is not even recommended for Vagifem users either. I have read that some gynaes suggest a progestogen challenge every couple of years to check if the lining is building up but I don't think this is commonly prescribed, and the British Menopause Society does not recommend this - and nor is it suggested on this site either:

"Low dose vaginal estrogen preparations can be used long term without causing any known systemic effect, and without needing any progestogenic protection of the lining of the womb."

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

I was offered a Mirena coil when I had a hysteroscopy a couple of years ago but because I prefer to use bio-identical products ( ie the same molelcules as our own bodies produce) I declined and use progesterone instead. The coil is very convenient though, if it suits you

Hurdity x

[Ljp]

Hi Hurdity, and thank you for your reply.

I have had the coil fitted today yes, and an estring.

I had been using serenity cream for several years, and estriol since May this year, had the bleed ( not heavy) for four days at the end of October.

I feel like I've maybe rushed into things, and am now doubting myself.
I was worried that if I didn't oppose the effects of the estriol cream , I might be in a situation where I have another post me no bleed no further hysteroscopy.

I felt my bladder issues were better using the estriol cream, but concerned that as gynae suggested it could have been the cause of the bleed, I went ahead with coil to protect lining of uterus.

Other than that, I do have bad night sweats, aches and pains, anxiety, mood swings, but felt I was coping ok, now feel confused by today's happenings, and feeling unsure about my decision.

Don't know what to think or do now 😢

[Hurdity]

I would get some oestrogen asap - either patch or gel. Here are the ones listed:
http://www.menopausematters.co.uk/treatafter.php

Your gynae is wrong - you did not need the coil to oppose the estriol cream I mean how could she say that if the lining is normal and thin?! As I say though - you are now in a position to have oestrogen HRT which should help with your symptoms. You can get this from your GP - just decide if you want patch or gel (or even tablet although transdermal would be preferable) and go from there.

The serenity cream would not have any effect in this respect, and in fact this demonstrates that it can't be used to protect the uterus othewise you wouldn't have bled.

Did you say you have an estring as well? Not sure how this works with a Mirena?

Try not to worry - but I would suggest it is not advisable to have a Mirena long term if you are post-menopausal and not using oestrogen because it is not intended for this purpose.

Hurdity x

[Ljp]

Oh blimey, feeling like I now have to go onto full HRT when I had just been pootling along using serenity, up until May this year when the bladder and urgency became too unbearable.

I feel scared and worried and really dont know what to do, hate all this trying to make decisions on what's best, what's safe etc, I can't cope!

[Dancinggirl]

Lisajp - don't be scared. Hurdity has given great advice. In a way this gynae has taken you down a road you probably ought to try - adding some systemic oestrogen to the Mirena and Estring may be just what you need.  You are still young and trials have shown that if you do have some systemic oestrogen for at least 5 years, it will offer good protection from heart disease and osteoporosis in the long term.  The Estring is something you can take out and put in whenever you want - I used to take it out to insert a big dollop of Multi Gyn Actigel, gave it a wash and put it back in - you can do this when you have sex as well if needed. The Estring will help the VA and hopefully the bladder problems but if you add perhaps one pump of Oestrogel as well (you can apply this at night to your inner thighs) you may find this helps all your symptoms - you may be pleasantly surprised how good you feel!!!.  Many of us a sceptical about the Serenity cream as it is oestrogen that tends to keep meno symptoms at bay to help the bones etc. and Serentiy only gives a very small amount of progesterone.
DG x

[Mary G]

Lisajp, I agree with the others and would say definitely get hold of some oestrogen asap.  Now that you have taken the plunge and had the Mirena coil fitted, you might as well try either the oestrogen patches or the gel - I prefer the gel because it is more flexible and you can adjust the dosage. 

This could all be a blessing in disguise.  You are very young to go without oestrogen for so many years and this is a great opportunity for you to try it.  I think you will feel much better for taking it.  Give it a go!

[Ljp]

Thank you, I am feeling a bit better, having just been out to teach my dance class and spoken to a few of the ladies, one of which is the same age as me, she has just gone on HRT she has Everel patches and progesterone tablets for 12 days, she said she feels so much better.

I have made an appointment to chat to my GP next Thursday I think I will ask to try something, what would you recommend I ask for? Oestrogel or Everel?

I am just so scared of cancer, even though my logical mind says to try it and see how I feel, it could be the making of me, I sure as hell haven't been myself for years! But then the cancer fear grabs me and I panic and doubt my decisions.

Feeling a bit uncomfortable still after the hysteroscopy and insertion of mirena coil, I guess it will take a couple of days or so?

[Mary G]

I would recommend you ask for Oestrogel because it is flexible and you can adjust the dose.  Please try not to be scared, there have been too many unfounded scare stories surrounding HRT and far too many women have endured years of life ruining symptoms through not taking it.  Many of these women then go on to face serious health issues like brittle bones, bladder dysfunction, hip replacements etc. due to years of oestrogen deprivation.

The flawed MWS has now been completely discredited by better research but it will take a while for the new guidelines and accurate information on HRT to filter through. 

[Ljp]

How does it work using oestrogen if you have the mirena coil? My understanding is that progesterone is used for 12.days of cycle even used in tablet form?

[Dancinggirl]

Lisajp
If you hadn't had the Mirena coil fitted you would need to take progesterone. The Mirena gives a small amount of progesterone continuously more directly to where it is needed - this is your uterus - so will keep the lining thin. The life of this Mirena is 4-5 years and then you have to have it changed if you are still using systemic oestrogen.  This is one of the plusses of the Mirena ( of course it also gives contraceptive protection if needed for those in peri meno)  - with this in place you can now simply add any amount of oestrogen you need without taking additional progesterone.  The Mirena often brings fewer progesterone side effects and controls any problematic bleeding and this is why it is so favoured by many gynaes.
You can add oestrogen  as pills, gel or patches and but most of us prefer the trans dermal route of patch or gel.  I personally like the Oestrogel as you have control over the amount you use - you can start with just one pump per day and then increase gradually until you feel the symptoms are under control and then maintain that dosage.  I am feeling really good on just one pump per day but most women do well on 2 pumps per day.
Do see your GP and get either oestrogen gel or some patches a.s.a.p and start to feel better.
Here is the section on this site that explains about the Mirena:
http://www.menopausematters.co.uk/to_progestogens.php
DG x

[Ljp]

Thank you AllThus forum is fab!

I have called my Dr, spoke to reception, and said what happened at hospital and that I would like oestrogel. Been told dr will call sometime today, and/or leave me a prescription.

Just a couple of questions.

Should I leave the estring in when I start using oestrogel?... Or  remove and use nothing local? Or remove and go back to using estriol cream?

Am I likely to get a bleed using mirena and oestrogel?

Thank you 😊

[Mary G]

If your doctor can give you a prescription for Oestrogel immediately, that would be fantastic - I don't see why this can't be done over the phone.

Depending on how much gel you take, you may or may not get periods.  The most common dose is two measures (or pumps) every day and you could start on that dose and see how you get on - the doctor will probably prescribe that anyway.  If you do get a lining build up, the Mirena will make it shed so no need to take any further progesterone.

I'm sorry, I can't help you with the estring, I have never heard of it.

This all sounds very promising and I think you will feel like a new person in the next couple of weeks and wish you have started HRT sooner!

Good luck.