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[AndieKC]

Hi Ladies

You have all been very helpful and reassuring in the past, and I'm sorry to be asking again about continuing mirena bleeds/spotting. I understand it is common and normal in the first year after mirena has been fitted (mine was fitted 11 months ago). I also understand that in perimenopausal women the bleeds are common, and 40% continue to bleed after a year of mirena fitting, but is it still normal in women who are well post-menopause to continue bleeding 11 months after mirena being fitted?

I went through menopause suddenly at 44, no periods for 2 years, then I went on HRT at 46. Switched to mirena + Evorel 50 patches 11 months ago, so I am now 48 and well post-meno. My worry is that I'm still getting these light bleeds, lately it's been every day, for a few weeks now, although they are very light, sometimes only spotting, and sometimes only ‘on wiping', but I have to wear a small pad all the time. I've had all the tests imaginable a year ago - hysteroscopy, biopsy all normal, biopsy again 6 months was normal. The Dr hasn't suggested measuring the endometrial thickness.

Are the bleeds still normal this late post-menopause, 11 months after mirena being fitted?
 
Forgive me if it's a silly question, are the bleeds/spotting different when caused by too thin endometrial lining, I.e. too much progestogen from mirena? Do they feel different compared to bleeds caused by lining being too thick?

The estrogen patches are controlling my symptoms well so I don't feel the need to go higher with estrogen. Should I just stop worrying about it?

P.s. more silly questions... would I know if the mirena was somehow dislodged? And any ideas on sex... I am too squeamish re blood etc, never had children so I am a bit of a wuss... any advice welcome,
And thank you in advance xx

[Hurdity]

Hi AndieKC

It does seem strange that the doc did not measure the thickness as this would give an indication of the cause of the bleeding. I imagine it was measurued but perhaps not reported to you? It is a fundamental thing to measure with any bleeding! Are you able to look at your results online at your GP practice website? I can read all the results of my tests and the reports.

No question is silly on here. I don't know about the type of bleeding but to me, intuitively, bleeding or spotting from endometrial atrophy (and potentially ulcerated lining) may well be lighter and sporadic whereas bleeding caused by an overthickened uterus will always be thicker and more like menstrual blood - as this is what has built up and must come away. Evroel 50 is not a very high dose so could be slight atrophy if results are all normal?

Sorry I can't help with the other Mirena questions and hopefully someone else will be along - there are lots of threads on the Mirena if you go to the home page of the forum and do a search - but maybe too many to find what you're looking for. As it was primarily developed as a contraceptive device then obviously designed so you can have sex with it in!

You might want to try the next dose up of oestrogen if you don't get an answer as to the cause and you get a measurement of your lining and it turns out to be thin. eg ask for 75 mcg and cut a bit off to increase a little bit initially and see if this makes a difference?

Hurdity x

[AndieKC]

Hi Hurdity
Thank you for your reply and your patience. I can't go to my GP / gynae with this as I have had to fight them for nearly a year the last time around when their response was to stop my HRT. Even with Dr Currie's involvement it was a long and hard battle. The gist of it was that both had been severely misinformed about HRT, put me on sequential rather than continuous tablets (they missed the fact that I was 2 years post meno at the time). The wrong tablets caused a bit of hyperplasia and there was a small polyp, all was removed, and resolved once they put me continuous progestogen. Then i was given mirena and Evorel 50 patches, I've been in these for nearly a year now.

The whole circus started but an innocent mention of bleeds to the GP... that's why I don't dare to go there again. But this time I did write to Dr Currie and she reassured me that bleeding does settle eventually.

Is there any way to have my endometrial thickness measured by ultrasound but without the GP knowing? At the gynae dept I cant choose a different doctor either because due to this consultant who is the boss of them all, they all have a very militant approach against any HRT. And that's after Dr Currie's involvement... i am tired of fighting their bloody ignorance. Every time I go there for something, another example of their lack of knowledge comes along. The last didn't even know I was post-Menopause. Because of my age (48) they assume I have mirena for contraception.

Anyway, as for the bleed, they seem to be sometimes just brown spotting and I can even see the odd small dot which is apparently part of the shedded lining. But sometimes the blood is bright red, fresh, but it's not as much as when I used to have periods.

As for the estrogen patch, I could always go back to using the whole patch - it is the small dose anyway, Evorel 50, and in the last 3 months or so I have been using only two thirds of the patch and seem fine on it. The reason I did that is to try if a lower dose would be fine, and also to hoard some patches. I will have to go for the prescription review appointment with the GP after a year, very soon, and based on my previous experience I expect all sorts of trouble. The GP is under the under the impression that any bleeding should stop within 3 months... I know it's wrong but I'm tired of fighting. And I have already changed GP surgery the last time around, at least this lot kind of listens to Dr Currie, it just took me months of battle.

But if you know if any way of getting a scan without the involvement of my GP and the gynae at the hospital, I'd like to do that. Then at least I'll know for sure if the bleeding is due to the endometrial thinning being too much, and up my estrogen. And if the lining is still shedding, then it will take more time for the bleeds to settle. There can't be any polyps etc as I had hysteroscopy a year ago, plus a biopsy in February, and polyp was removed during hysteroscopy.

Any ideas welcome... and thank you so much for your support, I feel so alone and sometime sooo angry that I have to battle for HRT like this. I couldn't do it without this forum giving me the strength...
thank you so much xx

[NorthArm]

Hi AndieKC

I'm not in the UK (Australia) but I remember reading a post on here from a lady who had gone to (forgive me, I'm not too sure of the name, as it's been years since I lived in the UK) Mothercare? Mothercraft? The big chain store for mothers. She'd had an ultrasound there with no referral and it cost her about £85 I think. They checked her lining and everything was ok. Might be worth a try if you can afford it?

Good luck xx

[AndieKC]

Hi NorthArm
Thank you so much for your post, you are right, there are private scans, a forum member sent me a link for it and it's in a health centre nearby, £90 for a simple endometrial scan like you described, or£190 fora full post-menopausal scan with ovarian check etc.

Thank you again, hope you're keeping well,
Xx

[NorthArm]

Hi AndieKC

You are very welcome, and I hope it all goes well for you xx

[Cacarosa]

Your Mirena could be displaced. It happpened to me. Were two years on it but it moved away from its position.
It got stuck in my cervix and had it surgically removed.
Go ask for an echo to check if its still in place, sometimes that's why it makes you spot all the time. Checking the strings won't be enough, I checked mine regularly and they would always be there but it doesn't mean the device is still in place.  If its displaced but caused no harm, you can get another one inserted just after the old one is removed.

[AndieKC]

Hi Cacarosa
Thank you for your post. It sounds like your experience must have been a nasty surprise... I have been thinking if it's possible for the Mirena to be dislodged after nearly a year. I am especially confused about the contradiction: all literature says that ‘a man will not feel the coil'. But when I feel inside with my finger (and finger is smaller than a penis) I can clearly feel one string hanging out loosely (this feels okay)  AND a bend of the other string which seems like an coat hanger sticking out of my cervix. Is this normal? Is this a sign that's something is not right? I don't have any other symptoms, no pain, no fever or any signs of infection. Coincidentally, I had a complete break from any spotting for a week, but I think it may just be starting again.

Did you get any symptoms when your coil got dislodged? Any pain? I only feel a very very tiny cramp very occasionally during the times of those light spotting episodes.

P.s. Husband is very understanding and diplomatic but sex life completely disappeared... once he called it ‘barbed wire in there'... sorry if it's too much information! Any advice appreciated!
Thank you very much xx


I remember after the insertion I had both strings hanging loosely which seemed better. But during the check appointment 4 weeks later the GP ‘bent' one of the strings, apparently that's what they do to tuck it in.
 

[Cacarosa]

Yes, I did notice the strings, and my ginecologist told me to check them at least once a month to assure I didn't expelled the coil. My partner didn't noticed them but when men complain about that, your ginecologist usually cuts them.
I noticed that something was wrong because had terrible cramps and non stop heavy bleedings for two months. Since two weeks before that I had my routine appointment and an echo, and there was nothing wrong so I didn't think it was displaced. I blamed it on the fibroids. And in the two years I had the coil inserted my periods came in time and long and heavy as always (no amenorrhea for me unluckily).
I think there's no accurate way to tell by yourself if your coil is displaced. You'd better consult your ginecologist

[AndieKC]

Thank you Cacarosa for your reply and advice, I will go to a local GUM clinic to have it checked. I'm very grateful for your help xx

[AndieKC]

Hi Ladies

I have an update I'd like to share. I went to have a private scan - the whole post menopause £190, highly recommend by the way. My mirena coil is indeed misplaced, that's what's been causing my constant bleeds. The coil needs to be removed, it slipped right down to my cervix. I bet it happened during a biopsy a few months ago, the doctor was like a butcher... now my gp is not available for 6 weeks, all GUM clinics are gone (they used to do mirena coils).

Need to go to a different Gp, still 2 week wait to see anyone! Will need a different form of progesterone as this is all part of my HRT. I am on estrogen patches Evorel 50.

Good news, my endometrial lining is 2.4 mm, so perfect, and everything is no normal. Am worried though that whoever I go to see to remove the coil, they will try to stop my estrogen too
I am 48 and menopause happens suddenly 4 years ago. Can't live without the estrogen... any ideas? How I can have the wretched coil removed and what other progestogen I can have?

Thank you xx

[Dotty]

Hi don't know what progesterone you have tried, but you could have Utrogestan or Provera or Norethisterone x

[pants46]

Andie, can you have the 'misplaced' mirena removed and a new one fitted ? Or are you done with the mirena now ?

[AndieKC]

Hi Ladies
I want to have it removed, it's obviously the cause of bleeding, a year after mirena insertion, and I am 4 years post meno. Had every test done before to rule out any abnormalities so it must be the mirena.

I'd rather not have another coil, never liked the idea, I was really forced into it by doctors, the price for having estrogen, long story.

The progestogen I had before was norethisterone, as part of Kliovance. Maybe a combined patch? I'll look at what options are out there. 
Thank you so much for your support xx