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Author Topic: Mirena bleeds/spotting  (Read 198 times)

AndieKC

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Mirena bleeds/spotting
« on: June 11, 2019, 08:29:44 PM »

Hi Ladies,
I hope itís okay to post this question here...
How long is it normal for bleeds to continue after the mirena has been fitted? What is your experience?

My menopause started early-ish at 44, I went on HRT tablets two years later and had mirena coil fitted last August aged 47. Iíve been on Evorel 50 patches ever since, works well to control flushes etc.
At the time of the mirena fitted (under GA), I also had hysteroscopy due to having simple hyperplasia without atypical. Also had a biopsy and a small polyp removed during the op. Biopsy showed no abnormality. 6 months later another biopsy, no abnormality. In August itís going to be 12 months since the mirena fitting, but Iím still getting mild bleeds/spotting. Very light, but I have to wear a small pad often, and sometimes itís only visible on Ďwipingí - sorry if it too much information... itís also quite random. Sometimes the blood is bright red, sometimes old, dark or brown, and sometimes only light pink. Iíd say the spotting is definitely getting less in volume and less frequent, but Iím getting a bit worried. GP was under the impression the bleeding needs to stop within 6 months, but Dr Currieís advice is that it can take a year. Articles on the subject also mention that the more hyperplasia there was, the more bleeding there is initially after the mirena is fitted. Is it normal to be still getting the bleeds 10 months or so after mirena being fitted?
And can heavy exercise bring it on? I do some weight training twice a week and HIIT cycling 3 x week, nothing too Olympic.
Your experience and opinions would be welcome,
Many thanks
Andie xx
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AndieKC

Dancinggirl

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Re: Mirena bleeds/spotting
« Reply #1 on: June 11, 2019, 09:19:18 PM »

Around 60% of women are completely bleed free with the Mirena.  You may find things settle gradually.
Your GP is wrong - itís continuous HRT regimes that should result in no bleeding after 6 months.
Look under TREATMENTS on this site - you will see in the progesterone section all the info on the Mirena - print this off for the GP.
DG x
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AndieKC

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Re: Mirena bleeds/spotting
« Reply #2 on: June 11, 2019, 09:23:03 PM »

Hi Dancingirl,

Thank you for your reply. Am I correct to think that mirena plus estrogen patches is continuous hrt as progestogen is continuously delivered via the mirena?
And did you mean that in the other 40% the bleeds continue ?
Thank you xx
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AndieKC

Dancinggirl

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Re: Mirena bleeds/spotting
« Reply #3 on: June 12, 2019, 08:43:07 AM »

Here is the section from this site about the 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 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. However national guidelines recommend that it can be used for up to 5 years for the progestogen part of HRT.


Yes, Mirena with oestrogen alongside would be considered a conti HRT regime but as this information states, it cannot guarantee you will be bleed free - so much depends on the amount of oestrogen used, where you are in your menopause journey and whether there are other causes for the bleeding e.g. fibroids. When I had the Mirena, I was post menopause and only using a small amount of Oestrogel ( 1-2 pumps per day) - I was virtually bleed free within 3 months but I still got occasional spotting going forward.  The Mirena is still the best way to protect the womb lining, prevent bleeding problems etc. and it will often, in time, shrink fibroids.
This HRT combo was the best I ever had with the least problems. DG x
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AndieKC

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Re: Mirena bleeds/spotting
« Reply #4 on: June 12, 2019, 09:55:12 AM »

Hi Dancinggirl
Thank you for your advice and the link.
I am happy with the combination, and have also been experimenting with cutting the patches to only use 2/3 rather than the whole patch but anything less and symptoms start coming back.

I donít mind the odd spotting, itís the doctorsí ignorance that worries, they use any excuse to stop the hrt. After the battle Iíve had I just want to get on with life so hopefully...

Never had any fibroids and in the past two years Iíve had all the test imaginable so hopefully thereís nothing sinister,

thank you very much for your reassurance
Andie xx
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AndieKC

Jinja

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Re: Mirena bleeds/spotting
« Reply #5 on: June 12, 2019, 01:03:10 PM »

I'm 3 years into my mirena and on a everol 100 patch and I'm one of the 40% who continues to have bleeds. I'm peri and I assume it's my own hormones in the background causing the bleeds as they have a similar pattern to before I went on hrt, very random months without then 2 in a month. I don't mind the bleeding but could do without the PMT  :-\
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AndieKC

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Re: Mirena bleeds/spotting
« Reply #6 on: June 13, 2019, 09:02:22 AM »

Hi Jinja
Thank you for your reply.
I am well post-menopausal, so the docs want zero bleeding at this stage. Hopefully with all these tests Iíve had thereís nothing sinister and the bleeds will eventually stop.

Thank you all xx
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AndieKC

Hurdity

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Re: Mirena bleeds/spotting
« Reply #7 on: June 13, 2019, 07:35:59 PM »

Hi AndieKC

When they did the second biopsy 6 months after the Mirena fitting - did they measure the womb lining - as that would be an indication of the extent to which the Mirena had thinned down your thickened lining?

Also if you are only using 2/3 of a patch then eventually with the dose of progestogen in a Mirena - the progestogen dose can be too high for that dose and can lead to overthinning of the endometirum. This can also cause ulceration and some bleeding/spotting. In your case if your lining was thickened maybe not but important to know how thick your lining is now I would say. Also as Dancinggirl says - if you are peri or post-menopause will affect whether or not you continue to bleed now and again. As you have read too - the thickened lining had to go somewhere so the strict 6 months rule does not really apply and especially if you are not post-menopause anyway! I thought it as 6-9 months anyway...

Hopefully you will be able to find out soon that all is well, to put your mind at rest?

Hurdity x
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AndieKC

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Re: Mirena bleeds/spotting
« Reply #8 on: June 13, 2019, 08:58:26 PM »

HiHurdity
Thank you for your reply.
Just to clarify, I am nearly4 years post menopause, last two of which I have been on hrt.
When I had the biopsy 6 months after the hysteroscopy & mirena insertion op, they did not measure the womb lining thickness - I wish they did! But it all happened so fast, the letters inviting me for the appointment said nothing about biopsy or taking painkillers, I even phoned to ask and they reassured me it was just a routine check up of the mirena. Then bang, youíre having a biopsy! No painkillers at all, worst pain ever, I am still having anxiety from it, I felt so Ďbutcheredí.

Can I please ask, is there any way to tell the difference between bleeding/spotting caused by too much estrogen vs bleeding  from mirena progestogen thinning the lining too much?
Thank you xx
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AndieKC

BobbingAlong

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Re: Mirena bleeds/spotting
« Reply #9 on: June 14, 2019, 12:13:26 PM »

Hi AndieKC
I posted on forum a few months ago wondering if it was normal to have almost continuous spotting after 18 months on Mirena. I've kept meaning  to pop back and update to say that shortly after that post, the spotting finally ceased. I'm at a diff stage to yourself as I am very much still in Peri and so I do still get mild spotting around the time of my period, which I can track easily as PMT symptoms always let me know it's on its way. However, the almost continous spotting the rest of month finally settled.
I'm on oestrogel and tostran. During that first year on Mirena, I did keep experimenting with the oestrogel dose and was trying keep it low (half pump) some of the time to try and alleviate breast swelling etc, but finally around 18 months I started flushing a bit more etc and increased to 1 pump and stuck with it. That first 18 months when I did have a period the spotting was much heavier than I get now (at almost 2 years since insertion) and even required a lilet mini tampon which I don't need now. So, I'm not sure if the oestrogel dose was too low particularly, because lining was definitely building up more then or if progesterone was too high or if my uterus was just "angry" with a foreign body in it!!? Its hard to know, but things have settled.... it just took a long time.
Hope that helps and I'm on here today to read as I've reached a point where I'm considering upping the oestrogel again as I'm a bit further into peri and symptoms flaring up again!  Trial and error.....  :)
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AndieKC

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Re: Mirena bleeds/spotting
« Reply #10 on: June 14, 2019, 11:45:08 PM »

Hi BobbingAlong
Thank you for your post,
Itís so great to have such a supportive community here! Hope you find your right dose and control the symptoms, to me hrt has been a miracle, it gave me my life back
Good luck xx
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AndieKC