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[TrishFlowers]

Hi there, I wonder if someone might be able to help me or put my mind at rest please?
I have had a Mirena coil in for the past 9 and a half year (the same one - I had 2 before that). I went to the doctor for HRT 4.5 years ago and he said that the mirena coil could stay in for 10 years and that I only needed a oestrogen only pill. so I have been on oestrogen 2mg for the past 4 years. when I went last week for a repeat prescription he suddenly said that on the computer it says the Mirena should be taken out after 7 years. He then said to put me on a new hrt pill that has both oestrogen and progesterone. However, he then phoned me the next day and said I should go for a scan to make sure my womb was ok. I have since been reading up and it says that you shouldn't take oestrogen only unless you have had a hysterectomy.
I am now really worried as I have been reading about endometrial cancer - which can be triggered by too much oestrogen.
So I assume that there is no progesterone coming off the Mirena after 5 years? Does anyone know any more about this issue? As it would seem like the ideas behind how long you can have the mirena in for has changed?
Thanks you

[Dancinggirl]

Hi and welcome to MM

Firstly - it's highly unlikely you have cancer - if you had bleeding because the womb lining had thickened then there might be a small chance that cancer could be developing.

For contraceptive purposes, I believe the Mirena should be changed every 5 years but for HRT purposes it should be changed every 4 years because the progesterone runs out by the 5th year.  Before the menopause you would be still be producing some progesterone so this would stop the womb lining from building up, even if the Mirena had run out of progesterone.   The Mirena with separate oestrogen as pills, patch of gel is a very good combination.  I would have your scan adn have another fitted and then carry on using the oestrogen separately. The Mirena protects the womb lining and is delivering the progesterone more locally to where ti is needed. 
Your GP is wrong, you should have had teh Mirena changed more often - he/she has only just realised this so is panicking in case you womb lining has built up!!!!  These GPs really should get up to speed on treating the menopause and the Mirena has always had a maximum life of 5 years anyway - where did he get the 10 year time scale!!!!? 

Here is the info from this site about teh Mirena as part fo HRT:
MIRENA
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
Price: £88.00


If you get on well with the Mirena with separate oestrogen, I would simply have a new Mirena fitted - this is such a great non hassle HRT regime. DG x

[TrishFlowers]

Hi and welcome to MM

Firstly - it's highly unlikely you have cancer - if you had bleeding because the womb lining had thickened then there might be a small chance that cancer could be developing.

For contraceptive purposes, I believe the Mirena should be changed every 5 years but for HRT purposes it should be changed every 4 years because the progesterone runs out by the 5th year.  Before the menopause you would be still be producing some progesterone so this would stop the womb lining from building up, even if the Mirena had run out of progesterone.   The Mirena with separate oestrogen as pills, patch of gel is a very good combination.  I would have your scan adn have another fitted and then carry on using the oestrogen separately. The Mirena protects the womb lining and is delivering the progesterone more locally to where ti is needed. 
Your GP is wrong, you should have had teh Mirena changed more often - he/she has only just realised this so is panicking in case you womb lining has built up!!!!  These GPs really should get up to speed on treating the menopause and the Mirena has always had a maximum life of 5 years anyway - where did he get the 10 year time scale!!!!? 

Here is the info from this site about teh Mirena as part fo HRT:
MIRENA
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
Price: £88.00


If you get on well with the Mirena with separate oestrogen, I would simply have a new Mirena fitted - this is such a great non hassle HRT regime. DG x

[TrishFlowers]

Hi Dancing Girl,

Thank you for getting back to me, although I am worried as I have had some bleeding - light and bits and bobs.......I cant believe that I went along with this as in my head I kept thinking it didn't seem to add up.

I'm also worried that they might have a job getting it out. Ive not heard about the scan yet but do you think I should chase it up? Will not having any progesterone for all this time be a problem for me?

I am really worried i must admit.
Trish

[Dancinggirl]

Hi Trish - I very much doubt there will be a problem - if you were getting a lot of erratic and heavy bleeding then there may be more concern.  Your GP has got things wrong but the scan will hopefully reassure you - it could be worth asking the surgery how long the wait is to get the scan appointment. I would also find out if you can have another Mirena fitted at the same time - when it came time to take my Mirena out, it slipped out really easily!
Let us now how you get on .  Dg x

[Hurdity]

Hi Trishflowers

 

As the doctor says - you need to have a scan just to make sure all is OK. The doc is shockingly negligent to prescribe oestrogen only HRT when your Mirena has been in for this long (ie not to know about the time length for changing it), and even though there is only a very very small chance of endometrial cancer developing ( as Dancinggirl says - bleeding usually happens when the lining gets too thick and only a very small proportion of cases have changes that lead to cancer) - he should actually push through an urgent referral and in fact you should insist on this ( as he has suggested you need one) to put your mind at rest, and also especially because you have had light bleeding.

As far as I know it has never been 7 years - for as long as I've been reading about it on this forum ( and definitely more than 4.5 years ago) the rule is change Mirena for contraception after 5 years and for HRT after 4 years.

Reassuringly - it does not actually run out of progestogen after 5 years - but the concentration is just not sufficient either for contraceptive purposes or for HRT. After 5 years, the daily release dosage is just under half that of the initial release dose. I don't think it has been studied beyond 5 years or if it has the data are not readily available. The point is, it has probably been giving out some progestogen for some time even if not at an ideal dose - so  this should have protected your uterus to some extent for longer than the 4 years recommended.

Nevertheless - have that scan but try not to worry. If all is well you can have another one inserted and continue with your HRT as Dancinggirl suggests - if that's what you would like to do - and depending on your age - it is recommended to at least 51/52 anyway if you have reached menopause.

Hurdity x

[TrishFlowers]

Thank you. I did ring and ask for the scan to be urgent and it's come through a week on Friday. I'm trying to be positive and not worry. Thanks for getting back to me.
Trish x

[Dancinggirl]

Trish - I have responded to you on the other thread. Just stop all hormones, have the scan and then see how you feel over the next 4-8 weeks and reassess. Let us know how you get on. DG x

[TrishFlowers]

Thank you! xx

[CarryWarry]

Reading this is so helpful to me and I want to thank you guys for your knowledge.  Today I am having the Mirena fitted after 18 months of trying various HRT.  I (as have mentioned in another post) can't wait to see if my daily headache and exhaustion will go.  I have had a light bleed for 10 weeks after taking Angeliq for 7 months.  Scan showed womb lining of 4.5mm....so just inside recommendation for coil thank God.  Will be taking estrogen tablet too but thanks also for your advice Re gel.  Will ask about this today. 👍🏼🤗. Interesting you say coil will only give out sufficient progesterone for 4 years as I was told 5 by her specialist. Will ask about this today too. Thanks all 😊

[Dancinggirl]

CarryWarry - if you look under TREATMENTS on this site you will find the info on the Mirena - so print this off to show the doctor as it clearly states that 4 years is the time limit for the Mirena as part of hrt.
DG x

[Dotty]

Hi recent fsrh guidance says the Mirena can be used for up to 5 years for HRT - endometrial protection.

See page 30:


https://www.fsrh.org/standards-and-guidance/documents/fsrh-guidance-contraception-for-women-aged-over-40-years-2017/fsrh-guideline-contraception-for-women-aged-over-40-years.pdf

[Dancinggirl]

Dotty - maybe trials have shown that the Mirena is ok for up to 5 years as part of hrt but the paper you shared is referring to contraception which is needed during peri meno but I wonder if 5 years is still appropriate in post meno? My understanding is that it's the progesterone the Mirena delivers that is crucial as part of hrt and if after 4 years this isn't sufficient then hyperplasia might occur.
Maybe this should be checked with Dr Currie so the info can be updated on this site if need be. DG x

[Dotty]

DG - page 30 is talking about HRT:

7.1.2 LNG-IUS for HRT
The Mirena LNG-IUS offers an excellent and highly convenient option for both contraception and endometrial protection as part of a HRT regimen. It is a licensed product for endometrial protection when combined with estrogen.83,84 There are extensive data showing that it is effective in providing protection from the stimulatory effects of estrogen on the endometrium.99,227–232 Unfortunately the data presented to the regulatory authorities from trials provided evidence of endometrial protection with duration of just less than 5 years. Therefore the LNG-IUS is only licensed for use for 4 years with HRT84 but most clinicians endorse use for up to 5 years off-label. To guarantee endometrial protection if being used with estrogen for HRT, the device must be changed every 5 years irrespective of the age at time of insertion.

Mirena is licensed for endometrial protection when combined with estrogen. It is currently the only LNG-IUS approved for this purpose.
It may be used up to 5 years for endometrial protection and needs to be replaced regularly when used for this purpose, regardless of age at insertion.

[CarryWarry]

Hi Ladies!  Back from having the coil fitted and asked the nurse fitting it the 4 or 5 years question, when used as an Hrt supplement.  She said FOUR years and disagreed with the view of my specialist, confirming progesterone can run too low in year 5. Thanks for your tips DG!  Going to explore this site now.