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[Jo24]

I will check with my Meno Consultant regarding what the (approx) systemic dose of Prog would be via the Mirena, but would be surprised if equivalent to Femseven patches, which deliver 7mcg/24hrs ? My understanding is that it's primary delivery is at a local level, hence its popularity with women who have undesirable side effects from Prog via other routes, and that it's systemic release is negligible. In addition, I assume it would be variable amongst users, and deteriorate as the device ages.
Data from clinical trials measuring serum levels would give this info, but I have not explored this avenue.
It will be interesting to know, but my personal preference is for non invasive delivery.

[Hurdity]

Hi Jo24

Have a look at this post I did just over a year ago where I looked into it and explained as far as I had researched from info on the web. I also have more notes on this re systemic concentrations. I was surprised to read from what I found out that actually systemic absorption from Femseven is lower than for most of the years of Mirena (because release rate declines over time) but as you say there is HUGE individual variation in systemic levels which amongst other factors depends on body weight and SHBG concentrations (Sex Hormone Binding Globulin) (but is in the same "Ball park" so very approximately similar in order of magnitude).  Nevertheless when compared with the COC and POP preparations containing levonorgestrel, systemic absorption (from Mirena) could be said to be minimal - but only in comparison with these. After all the Mirena was initially developed for contraception and heavy bleeding so was a godsend to women for whom the large doses of (oral) progestogen in these other preparations gave too many adverse effects. The advantage of course for use as part of HRT is the ability to alter the oestrogen dose independently of the progestogen which isn't possible in the transdermal Femseven patches. https://www.menopausematters.co.uk/forum/index.php/topic,34500.msg550449.html#msg550449

I would be interested to hear what your cousultant says and the data s/he quotes.

Hurdity x

[Jo24]

Oh blimey, the plot thickens re the Mirena and systemic effect; I will take a look at what you have picked up online and see what I make of it; I can enlist the help of my husband should there be anything beyond my intellectual capabilities 😉
I understand the Mirena's potential benefits. but am also mindful of the potential issues regarding an invasive device, including the lack of 'control' over delivery, and the inability to simply remove it yourself should you have particularly adverse side effects given that this may be more than the 7mcg/24 hrs of Levo that I am currently px. On balance, I am erring towards plodding on with transdermal if possible....

I have no issues at all with the adhesion of the Femseven patches (in fact I have to 'dig' a bit to get them off at the end of the week) but apply to warm skin in the lower abdominal area, and press firmly for 2 mins +
I do have an appt in April to see the Meno Specialist again (which includes another TV scan)  and usually make a note of things to discuss in advance which saves the mental 'oh, I forgot to ask' on exiting the building bit 🙄

[amy1235]

My mood seems to be improving on an increased dose of Femseven Conti 50mcg/7mcg as advised by
telephone consult with my Meno Consultant ('try a patch and a bit') and see me in 8weeks.
She agrees that I seem to require continuous Prog along with the Oest for my mood after experiencing increased anxiety and the return of insomnia on Sequi patches.
Some forum members seem to be very 'anti' towards the use of continuous Prog systemically, and advise the Mirena coil?
I do not think this would be of benefit ito me personally, and suggest it is important to recognise that some ladies 'need' systemic Prog - it is not the Big Bad Wolf for us all...

Those women who are OK with progesterone or progestogens in general may get on better with continuous progestogen preparations because they avoid the fluctuations of  cyclical preparations - as it is often these fluctuations that many women are sensitive to - just as in peri-menopause, and the menstrual cycle. It may well be not because of the need for continuous progesterone to give beneficial effects, but the absence of adverse effects (due to having consistent amounts of both hormones) if you see what I mean?  Mamachunk - sounds like this is you!

Some women find all synethic progestogens give unwelcome side effects amd seemingly become more sensitive at menopause eg women on here reporting that they have been OK on the CCP in younger years yet not with the same progestgoen as part of HRT. The Mirena coil does give systemic progestogen - just not as much as the same progestogen when given in the mini-pill -  hence its publicity for women as better for contraception. As HRT though I worked out that it gave approx the same order of magnitude of systemic prog as a Femseven patch - but can't remember at what point in the 4-5 years cycle of the Mirena this was for!

Yes progesterone particularly has a sedative effect which some women welcome - but it has to be taken in very large doses orally as HRT because it is unstable and much is lost through digestion and metabolism through the liver - and it is the large concentrations that give the unwelcome side effects to many women - ie going beyond a calming effect - into fatigue, headaches, lethargy, foggy head etc.

Re blood sugar - there is an interesting article about what happens throughout the menstrual cycle and the different effects of the two hormones - although unfortunately there are no sources for further reading...
https://www.myhormonology.com/female-hormone-cycle/

Synthetic progestogens appear to be more risky in terms of breast cancer - but probably not progesterone itself.

Hurdity x

Hi there- I've been searching through the forums regarding continuous progesterone use as I'm fed- up of having bleeds  which tend to be heavy and  take it out of me for days- I feel I've done my duty to God and the Queen in this department......! I'm 56 and just want to be period free. In the last year I've cut down my estradot  patch dosage to 50mg from 75mg and over the last three months have been snipping a bit of the 50 patch to see if I can perhaps manage the 37.5mg patch. This moth I've decided to try taking one Utrogestan pill of 100mg orally at night ( thought I would try the day 1-25 method just stopping for the last three days) to see if I can eliminate the bleeds. Today is the 3rd day of my nightly progesterone pill
( was taking 200mg utrogestan vaginally from day 15-25 previously)..I'm a busy person at work and especially today have felt weak, dizzy and slightly panicky .....however I also recently had another bppv attack and am terrified of getting vertigo, so could it be that? I'm wondering if the 37.5 patch is enough to balance the continuous use of the progesterone? Or perhaps I'm experiencing symptoms due to low estrogen ? Or should I try a combined patch of some sort and does anyone have any advice about this? I'm at my wits end, don't know what to do to feel better. Any suggestions would be so appreciated