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[Shannonplussed]

Is the progesterone dosage in Mirena considered low, moderate, or high? What's the correlating (max) Estrogel dosage to pair with it? (obvi using less if symptoms allow). Also, has anyone here found Mirena to actually be insufficient for their personal progesterone needs (or progesterone + estrogel to balance the ratio), and had to supplement with additional progesterone?

[Sleepy123]

I'm due to have a Mirena coil fitted, so I would also be very interested in the answer 

[Tinkerbell]

I thought that the Progesterone was considered low as it is delivered into the uterus, i use three pumps of Estrogel to control symptoms.

I am not sure how you would know if the progesterone wasn't sufficient unless you were having scans to see if lining was building up, can you explain more on what you mean?

[Shannonplussed]

It's more a hypothetical question, really. I had a Mirena before menopause and into perimenopause and had no bleeds after it settled, until the 4th year when peri reared its nasty head. I wonder if there's enough progesterone in there for someone with quite high estrogen, say like in the throes of perimenopause when estrogen can briefly skyrocket or for someone who needs to take a high dose of estrogel to manage symptoms. It seems like many on here have trouble with progesterone, but I'm one of those that does well with it. So just curious if anyone has had to supplement Mirena with additional progesterone?

[Tinkerbell]

I use 3 pumps which is considered high, i am post meno. In all the time, apart from the initial 4.5 months of spotting, i have only had a couple of smears of blood  so i guess lining is not building up. My GP wasn't  concerned and said a scan would only be offered if bleeding heavily/frequently.

[elsie001]

I'm 53 and on my 2nd mirena.  I'm also on Elleste Solo 1mg.  Very occasionally, I will get a small amount of bleeding.  I've had all the tests and my GP concluded that it's probably the odd hormone surge causing it.

[Hurdity]

The progestogen in the Mirena is actually pretty high as it is sufficient to stop periods sometimes in fertile women - but delivers progestogen straight to the uterus with minimal systemic absorption (so in this respect is "low"). It is often considered to be "overkill" by some women who are post-menopause and using HRT and the lower dose Jaydess would be preferred - except it isn't licensed for HRT purposes unfortunately.

If you are using it with a high dose of oestrogen, post-menopausal and bleeding continues beyond the first 6-9 months then this needs investigation as there should probably be no breakthrough bleeding from a normal uterus once post-menopausal and on HRT.

The thing is is you are in the throes of peri-menopause Shannonplussed, with very high surges - then yes you may get the odd bleed but if this is due to your own cycle coming into play and ovulation, then you will be producing your own progesterone - Mirena does not always suppress ovulation.  Like elsie001 says - if you get the odd hormone surge leading to spotting or bleeding after an absence of this, it means you may still be peri-menopausal?

I think there is a thread current at the moment where someone has got a Mirena ( over 4 years old but not yet 5 years old) and has been given additional progesterone - but some of us think this might well be too much. Can't remember which thread!

Hurdity x

[Shannonplussed]

I'm not ovulating anymore. I think I will switch to another Mirena just to have one less medication to worry about despite tolerating the oral progesterone well. Mirena worked well for me in the past, when I was pre-menopausal and had repeated unexplained bleeding after sex--it fixed that up, and I had no bleeds until the 4th year. I ovulated very infrequently, if ever, on it. I'm okay with the overkill, and in fact it may be exactly what I need.

Bottom line, what is the max estrogel dosage to pair with it? (I know I'll be fine with my two pumps daily, but I'm just not finding a cutoff anywhere.)

[Tinkerbell]

You can use up to four pumps of Estrogel.

[Shannonplussed]

Thank you!