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[chris65]

Hello,
First let me apologise for the long winded message but I need to say it all to get to the point lol.
I had around 4 years of blood tests showing I wasn't menopausal but I had night sweats, really bad mood swings, irregular heavy periods, panic bouts and felt completely insane at times.  My peroids finally just stopped out of the blue and a blood test showed I was menopausal and so I started on Femoston 2/10 last October .  Within the first week of taking it I felt fantastic and couldn't sing its praises enough, no more night sweats, a decrease in mood swings, actual fun happy conversations with people.  In the first 2 months I even gained energy to exercise again.  The first 2 months I had quite bad diarrhoea towards the end of the 1st week of progesterone (for the last 3 year I have had hormonal IBS so presume the tablet change is a trigger) and then during the 2nd week I had a period, 5 days middle 2 quite heavy. GP told me to go back after 2nd month for bp check and to see how I was doing, I advised of above and said although the diarrhoea & heavy bleeding was annoying I felt so good the rest of the time I could put up with it - famous last words!  3rd month I started with diarrhoea on 3rd day of progesterone which went on for a full week then I had a dark discharge but no real period and kept getting stomach cramps but wasn't sure if this was IBS or period pains.  These both went when I began my estrogen on my 4th month but then at the beginning of the 2nd week of estrogen my diarrhoea began again and I had a very heavy period for 4 days and felt drained but presumed it was just a late period as I hadn't really had one the previous month but then a week later at the end of my first week of progesterone the diarrhoea began again and last Thursday (day 10 of progesterone) I began my period again.  I started estrogen on Monday and since Monday the bleeding has been terrible, even had to get up in the night and change myself and the bedding!!  I've been to the GP today, still flooding, and she has told me to stop the Femoston and go back in 2 weeks with the thought of changing HRT and has suggested perhaps the Mirena coil and Estrogen patches.  This is where I need some advise please - during the last 4 years I've tried the Mirena twice, once just for a month and second time I managed 2 months, but I had continual bleeding - not much but it was continual, migraines, felt like killing someone, anyone most of the time and went completely off sex, in fact the 2nd time my husband did actually say it was either the coil or him that needed to leave!  So you see I really don't want to go down the Mirena route again but I cant find an alternative progesterone other than either tablets or coil but I have felt so much better, normal etc on HRT I really don't want to try to get through menopause without it - can anyone give any advise about what I should do?

[BeckyBoo]

Hi Chris

I can't advice you as only just started my hrt and had my M coil fitted tuesday but just felt i wanted to give you a big  as sounds like you have really been through it.

I'm very nervous about the next few weeks not knowing if the coil and hrt will suit me. seems a mine field getting it right.

Hope someone can give you advice

BB

[chris65]

Aw thank you for the hug, I still don't know how to put the emoticons on here lol. 
Yes it is a minefield and everyone is so different, each month as a teen I couldn't wait for the day my periods stopped but no one warns you that it takes years of emotional hell before they do!!  My friend has the Mirena and says its changed her life and is the best thing ever but it really wasn't for me, the GP has said it would be different this time as I would also be having estrogen which I wasn't before as it was just to stop irregular heavy periods but its that not knowing what will affect you and what wont that's the problem!

[Hurdity]

Hi chris

Sorry to hear about all of this - sounds like your digestive system is not coping! This would affect the amount of hormones you are absorbing and could give rise to the irregular bleeding etc that you are experiencing ( unless it is also partly due to your own cycle kicking in as you may not have reached menopause yet).

You have already been advised to use transdermal HRT so if you are sensitive to progestogens - the synthetic type and including the Mirena then your only answer is progesterone itself ie Utrogestan, This is a squashy capsule containing micronised progesterone which is identical to the progesterone our own bodies make.. It is licensed in UK for oral use only but if you have digestive issues and problems with side effects then vaginal use would be preferable. Can you ask for a referral to a specialist menopause clinic?

If not - then ask your GP for the patches, but instead of the Mirena ask for utrogestan which may be listed as micronised progesterone - mentioning your issues with Mirena in the past.

Unfortunately irregular bleeding is common in peri-menopause but your first option is to try the progesterone and patches (or gel), and if you can tolerate the progesterone but still have heavy bleeding then a physical option would have to be considered eg abaltion. The treatments for bleeding are listed here:
http://www.menopausematters.co.uk/heavyperiods.php
http://www.menopausematters.co.uk/periodtreatments.php

Hope this helps

Hurdity x

[Dancinggirl]

Hi and welcome to MM chris65
Hurdity has given you a great response but her are my thoughts:
There are number things going on here which I think need to be considered.
How long was it after your last period that you started HRT? Blood tests are notoriously unreliable so you may not have been truly post meno! Unless you are at least one year without periods or over 54 it is often difficult to tell whether you are truly post meno. If it was under a year since your last period then you are probably still peri meno so your own hormones will still be fluctuating and declining.
You were put onto a medium dose HRT which may well have been too high to start out with, especially if you still had some of your own hormones - this would result in a build up on the womb lining and this often results in erratic and heavy bleeding.
Has you GP suggested a scan? This would be a good idea to check whether you have any fibroids that could be causing the problematic bleeding. I wouldn't march into an appointment and demand this, simply express your concern that the bleeding seems excessive and you have heard that a scan is usually advised to check for anything untoward and you need reassurance.
If you reacted badly to the Mirena in the past then this is probably not the best idea - it can be great if you are not too sensitive to the progesterone - from what you are saying the progesterone in this doesn't suit you. Femoston is a good HRT type (it has a kinder progesterone) and despite the bleeding you clearly felt good on this which is great. Sadly you can't get the progesterone (Dydrogesterone) which is in Femoston separately (one used to be able to get this!!) but you may find that Provera suits you OK. There is also Utrogestan but it is not as good at controlling bleeds as other forms of progesterone - I had problematic bleeding on Utrogestan.

Finding the right HRT is trial and error I'm afraid. I am approaching 60 and started my meno in my mid 30s so have tried just about every HRT type going. I certainly not an expert but My suggestions would be:
1 Ask for a scan to check your womb lining.
2 After a 4-6 week break from HRT and when the bleeding has stopped completely try Femoston 1/10 for 3 months - so try the lower dose.
3 If the bleeding is still problematic then ask to try the Oestrogel (just one pump per day) with Provera for 12 days each month. Many women do well on Provera as it is one of the kinder progesterones.
4 If you react really badly to the Provera then try Utrogestan (your GP probably won't have heard of this so tell them to look it up under micronised progesterone).  Utrogestan is prescribed to be used orally but some women use it vaginally - if you suffer with IBS then the vaginal route is probably not a good idea.
5 - Your IBS - this is a tricky one as this will often flare up at the meno anyway and many women find it can settle with HRT, while others find HRT will trigger it.  I assume you watch your diet and know what can trigger your IBS? Have you had any investigations or treatment for IBS? One of my main triggers is stress!!!!

You sound so anxious about all this and I know it can feel overwhelming but you do need to be patient.  I now practise Mindful Meditation (on the suggestion of my very good GP) and I am finding it helpful when I feel overwhelmed and stressed.
Go into your next appointment with questions and stuff printed off from this site - do stress that you have had really bad reactions to the Mirena in the past and would like to try other options first. - I always write everything down these days and find I get a far better outcome from the session.
Keep posting DG x

[BeckyBoo]

Glad it worked for your friend. It is bloody  that us women are ruled by our hormones and we just have to get on with it.

As i am only 42 i have had to have the m coil so i can try hrt (estrogen only). I know realise i have been going through the peri bit for a few years now which is no surprise as had to have ivf to get my daughter. I have sort of ground to a halt these past 6 months with tiredness, dizziness and feeling sick so just praying it helps and i can feel normal again.
 
BB x
 

[chris65]

Hello,
Thanks for your replies.  I'm not sure whether my IBS causes the hormone problems or whether hormones cause the IBS as they both started at the same time.  When it all began I was referred to a Gastroenterologist and external & internal ultrasound, CT scan & colonoscopy,  and made a diary to find triggers and they decided that it was IBS and gave me Fybogel & merbeverine. I have had problems determining triggers as someweeks its anything I eat, other weeks its dairy (apart from chocolate, I can eat loads of chocolate lol) some weeks its bread.  I do know that the more anxious I am the worse it is and although I have diarrhoea on HRT I don't have the IBS pain that I was having and I do think this is because all my anxiety disappeared whilst taking Femoston and my IBS was much, much better one of my main concerns is that by not taking HRT the anxiety will return and the IBS will get worse.  After loads of research and more diaries I think its hormonal as once my hormones were sort of controlled the IBS was controlled too but my GP says its the IBS that has upset my hormones.  I am 51 now so average age for menopause.  Its not that I'm not willing to try the Mirena its just that I cant cope with the continual bleed and the mood swings, the GP seems to think I won't get the mood swings or loss of libido when I take the estrogen too and says the bleed will die down and perhaps even go altogether if I give it 6 months so perhaps I'm just being a bit mardy I don't know, I just don't want to go back to feeling miserable and angry all the time and no one liking me - including my pet dogs lol.  I'm due to go back to my GP in 2 weeks when hopefully my bleeding has stopped or at least calmed down a bit and discuss options so I may ask for a referral, I just feel as though when I ask for a referral I'm sort of telling her I don't trust her or believe her
I had regular normal periods every month up until around 4-5 years ago when it all began and then they became a little irregular at first then I started having spotting inbetween periods, which is when I had another internal ultrasound and first Mirena was fitted.  2 years ago I started having heavy periods every 3 weeks along with night sweats etc so tried the Mirena again. Then last August my periods just stopped out of the blue but my sweats, anxiety, mood swings etc got a lot worse and I had a blood test and GP said I had begun menopause and offered me the HRT in October.

[Dancinggirl]

Hi chris65 - the info you have given us is very helpful.
You are technically still peri meno - so this will mean that your own hormones will still be kicking in but also gradually declining.  Femoston 2/10 would probably have been too high a dose to start with.
Your GP is right about adding oestrogen with the Mirena as this may work better than when you had the Mirena alone, particularly in relation to mood and libido - so this combo could be worth trying. I think the reason your GP thinks the IBS may be upsetting your HRT is that diarrhoea can effect the uptake of the HRT in tablet form so you may simply not have been absorbing enough from the Femoston to control your cycle. The Mirena and possibly Oestrogel(or oestrogen patch) is all transdermal so any digestive problems won't stop the absorption of the hormones and could keep you on a more even dose.  i had the Mirena for 4 years post meno and found it OK - yes, one does get some bleeding and spotting for the first few weeks/months but it usually stops all bleeding within 6 months.  The Mirena is a favourite among many gynaes because it often solves erratic and problematic bleeding, it can shrink fibroids if you have them and also less progesterone is absorbed systemically therefore fewer side effects.   If you had the Mirena before and not given oestrogen then your may have been rather dominant in progesterone and this could have caused your problems.
Your GP does sound more 'on the ball' than most so I'd be inclined to go with her suggestions at this stage - you may be surprised!!!
I'd try Oestrogel as you can start on one pump per day for a few weeks then gradually increase if needed - it is a nuisance having to apply it everyday, either morning or evening, but I have used it for many years and just make it part of my routine - many women love the patches but I found they didn't absorb so well.
Coping with anxiety is difficult and HRT won't always solve this completely so do consider so CBT/ Mindful Meditation to help with this - it may really help your IBS.
Good luck  Dg x

[Mary G]

chris65, sorry to tag onto this one late but it took me a while to read your posts.  I hope my experience can help.

I have had two Mirena coils, the first one was fitted in 1998 for contraception purposes and the second one fitted in 2005 also for contraception purposes.  Looking back, it dampen my libido and also caused breast pain and discomfort.  Once I started the menopause and my oestrogen levels dropped, it started to cause silent migraines (migraine aura without headache).  Because I had the Mirena coil, I was able to start using an oestrogen patch straightaway and it did help to some extent but I still didn't feel particularly good and I still had the migraines but I never had any breakthrough bleeding or periods.  The problem I had with the Mirena is that not all of it stays in the womb and because I am severely intolerant to all types of synthetic progestins, even that small amount was enough to cause problems in my case.  Many women don't have this problem and get on very well with it so it depends on how badly intolerant you are.   

I then had the coil removed, tried oral preparations, had a year off HRT altogether, didn't have any periods but my thermostat was not working properly and I had difficulty adjusting to different temperatures and I broke into a sweat far too quickly.  I also had night time panic attacks and generally felt half baked and not quite there.  I then went onto oral preparations which did absolutely nothing, tried Angeliq, a continuous combined HRT which was still no good so I slapped a patch on to top up the oestogen and again, it was an improvement and it stopped the migraines but I still did not feel good.  I too had digestive problems with the oral preparations all of which gave be indigestion.

The gynaecologist suggested I stop using this method and prescribed patches and Utrogestan but I was not getting enough oestrogen from the patches and the migraines started again and I also had heavy periods.  By this time I was pretty fed up so I made an appointment to see Professor Studd and he prescribed 3 pumps of oestrogen gel and 100mg of Utrogestan for 7 days each month plus a small bead of testosterone every day.  I felt much better on the gel because absorb it well and was finally getting enough oestrogen but I had migraines during the Utrogestan stage. 

To cut a long story short, I have now reduced my gel dose to 2 pumps every day and now split the dose to 1 pump every 12 hours to keep the levels stable.  I also use the Utrogestan vaginally because it has fewer side effects (like breast pain) when taken in this way and it also works better because it hits the spot, doesn't get lost in your digestive system and you can use less of it and get the same effect.  So far, it seems to be working and keeping the migraines away and luckily my period are lighter and shorter.  I think it is fair to say that I finally feel back to normal and roughly the same as I did when I was 30.

It has taken me years to get to where I am now (I am 54) and I think an HRT regime along the same lines would probably suit you well.  You certainly don't seem to get on with oral HRT and there seems to be a question mark over the Mirena coil so the gel and Utrogestan could be the answer as Dancinggirl has also said.  It really boils down to how intolerant you are to the progesterone part of HRT.

I would like to think that others can learn by my mistakes.  I hope this helps.   
 

[anna123]

Hi Chris,

I don't have any answers I'm afraid  but I can relate. I'm also on Femoston 2/10. I've been on it for 2 years. started off on 1/10 which had little effect but once I went on 2/10 I felt fantastic. I love it and am also very reluctant to stop taking it.  My problem is similar to yours-  over the last 3 months I have had excessive bleeding and feel drained half the time from it.

I am seeing my GP next week and hoping to get a scan referral and an appointment. I'm 41 and have no intention of stopping taking HRT, just don't want to have to start  trying others again. I am reluctant to have a coil fitted too   

[chris65]

Thank you for all your replies.  I feel much more informed now.  I do feel my GP I clued up on this and will listen to what she recommends but I now feel confident to ask about the other forms of HRT and get her opinion on those v Mirena.  I go back on 19th Feb and will ask for a scan first just to put my mind at rest more than anything else and I'll keep you posted what happens :-)

[chris65]

Ok so been back to GP and really confused now!  Firstly let me correct my earlier post I was taking Femoston 1/10 not 2/10. Secondly I apologise again for the long winded post.
Once I stopped taking my bleeding stopped within 3 days and so did my diarrhoea, in fact its gone the opposite way now and I'm only going to the loo, with difficulty, every 4 days!
Went back to my GP on Friday and previous to this visit I did feel she was clued up on Menopause and felt I could trust her and go with what she recommended but my opinions have now changed.  She asked if the bleeding had stopped and when I said it had she just said everything must be ok then and we'll prescribe some other tablets as I know you don't like the Mirena.  I tried to explain that if she thought the Mirena & Oestrogen gel was best I would give it another try, I just didn't want the headaches, loss of libido and mood swings I had last time.  She didn't seem interested and said she thought we should give tablets another go.  I asked if it was possible that I was intolerant of oral progesterone but she said as I had taken Norethisterone to delay my periods before they stopped this was highly unlikely.  I asked if I should have a scan to ensure everything was ok after such heavy bleeding and she said if the bleeding hadn't stopped then yes but as the bleeding stopped this wasn't necessary.  I asked about using Utrogestan as a pessary and she said she hadn't heard of it so looked it up in a book and said this was oral and not one she was used to prescribing, I said I had been on here and although it was classed as oral it was also used as a pessary but she was adamant it couldn't be used this way, at this point I felt as though I was annoying her so went back to asking what she suggested as the 'fog' had already returned along with lingering headaches that weren't really headaches and the very life like dreams that wake me up crying some nights.  She said I needed to stay on a low dose oestrogen as I'd only missed 2 or 3 periods so wasn't classed as fully in the menopause and thought a tablet with a different progesterone to Femoston would be best and gave me a prescription for Cyclogest 1/10 as this contained Norethisterone at a low dose and I've had this before at a higher dose - I did point out I never took it for more than 4 days as I got really bad head aches but she seemed ok with this.  Went to the chemist who advised this drug was now discontinued!! Went back to GP and receptionist said to leave it with her and call back Monday for a new prescription - Just been back and have a prescription for Elleste Duet 2mg - now I'm confused as she said on Friday I needed a low dose oestrogen and this one is higher!  I'm now unsure whether I need to go back and point this out, or whether to try them first or if because its a different oestrogen its a different strength  - Anyone any ideas or advise?

[Dancinggirl]

Oh chris65 - all very confusing.  I'm afraid Utrogestan is not licensed to be used vaginally on the UK, so a GP won't prescribe it for vaginal use - though many do use it this way. I have to ay when I tried using Utrogestan vaginally and it effected my bowels in a strange way, so if you have IBS I wouldn't use it vaginally.
I do agree with the your GP that a low dose is best in the peri stage and you have been given the wrong prescription - I'd ring and ask for a prescription for the lower dose of Elleste duet sequi.  Give it a go - you may find this one works well for you.  Dg x

[chris65]

Thanks DG, I left a message with the receptionist yesterday afternoon to just check the strength with the GP so hopefully will hear back today, will be annoyed if I have to pay the double charge again though but think I'll have to

[Hurdity]

Oh dear!! Sorry to hear about the problems you've been having.

As for Cyclogest - I had no idea it had been discontinued but this is not norethisterone - it is "natural" ie bio-identical progesterone which is used as a pessary or suppository to provide progesterone support in pregnancy (in the same way as Utrogestan is) but also given off licence by some GPs and gynaes as the progesterone part of HRT.

How strange for your GP to prescribe this for HRT and yet not Utrogestan  (which is also available vaginally for pregnancy support)? Also it seems to me she has missed the point about your digestive upsets on oral HRT.

I also can't understand why you have been prescribed Elleste instead of Femoston and especially the 2 mg as you recognised because it is higher dose. I have no idea if different progestogens have different effects on the digestive system so that you might potentially tolerate Elleste more than Femoston but my view would be you should change to transdermal HRT rather than a tablet at this point. I mean if you have IBS this should be fundamental?

I don't know what to suggest other than to refuse the prescription and ask for transdermal HRT or go with Dancinggirl's suggestion and just try the lower dose Elleste and see how you get on?

Hurdity x