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[Alex 2024]

Hi Everyone,
I'm nearly 54 and started HRT at 50  - occasional spotting/bleeds so don't know if I'm peri or post menopause (and does it matter.......?)
I'm on Everol 100 oestrogen patches.
I was on Utrogestan tablets for 14 days of the month but found they made me moody/unhappy,tense in a way I never had before menopause so I had a mirena coil fitted 8 months on the GPs advice. She said it could take 6 months to bed in.
I'm not convinced it's working for me....
I suffer EVERY day with feeling super tense / highly strung and anxiety.
Also over the last few months I've been getting joint stiffness that doesn't seem right for someone of my age and fitness - I'm pretty fit, average weight, don't drink or smoke and eat pretty healthily.
I also often get waves of feeling clammy - not hot flushes but like very vey light versions of hot flushes.
My brain fog is bad too.
I'm currently taking a small amount of Mirtazapine to help the anxiety - I hate taking this but feel like I can't cope without it and am also cutting out venlafaxine very very slowly as although this was prescribed for me it never ever suited me or helped my anxiety.
My main question is how do I know if the mirena coil is working for me - is this form of progesterone as good as it's going to get or whether there are other options I should consider and if so what are they. I am now so very fed up with this all (been feeling rough every day for nearly two years now) I may even consider a hysterectomy - which seems ridiculous - removing a body part just because I can't get my hormones balanced.....
Should I ask my GP to take out the coil..........?
What else could I try.......?
Thanks in advance and hope you're all having a good morning

[Dotty]

Hi it could be that your oestrogen levels aren't high enough as what you describe are symptoms of low oestrogen.  A 100 patch is the highest licensed dose so you could try changing to gel and see if that works better.

[bombsh3ll]

It does sound as if you are undertreated estrogen wise.

This would be worth addressing first rather than removing the IUS.

That said, whilst the progestin in the IUS is supposed to act locally, many women do report systemic side effects and if this persists despite adequate estrogen then removing it is reasonable.

Some people can be intolerant to progesterone however the dose for cyclical is usually twice as high as if you were to take it continuously.
At 54 you should be able to take a lower dose every day, which you might tolerate better.

Also you could try taking it vaginally.

There are also other oral progestins that can be used - some tolerate these better than micronised progesterone.

Finally there is tibolone - this is another good option for progesterone intolerant women.

If all else fails though, hysterectomy can be done for this indication however it is unlikely to be funded by the NHS, at least not without a fight.

[sheila99]

Did you keep a diary so you can look back and see how you were when you first went on it? I agree that your symptoms seem to be low oestrogen ones though. You may be able to add another 1/4 patch to trial without them noticing (some fell off  ). If it works you could see a specialist (private or long wait for nhs) and gp should then prescribe the higher dose.

[Alex 2024]

Hi,
Thanks everyone - I hadn't considered that it might be low oestrogen. I'll try another 1/4 patch and see how I go.
There was a time when I first started hrt that I was feeling very anxious and had a blood test which showed that I had too much oestrogen and I felt better when I cut back. But that was around 3.5 years ago and I guess my natural levels will have dropped by now. I'm wary of taking too much because I know it's about the balance - either too much or too little causes me anxiety.
Have a good weekend everyone x

[Hurdity]

Hi Alex - it's tricky trying to work out what to do for the best and especially as you are also taking other things - withdrawing from the venlaxafene and taking Mirtzapene. You can't really know what is causing what effect.

In the absence of any other explanation for your light flushes it could well be that the oestrogen level is inadequate. However have you had other tests for thyroid, blood sugar etc to rule out other causes for your physical symptoms?

It's a myth by the way that Mirena acts locally or rather only acts locally. It is always absorbed systemically but results in far lower systemic levels than the equivalent oral contraceptive POP - which is why this c omparison is always made. That is irrelevant for women who use it as part of HRT. You may well be suffering from side effects, though as the others suggest I would make sure oestrogen levels were OK ie that you are absorbing from the patch, and ask your doc to check out your general health by means of blood tests etc.

Also I wouldn't do anything drastic until you've finished withdrawing from the AD and hopefully eventually stop taking the other one so that you can work out what you need to do. It would be frustrating to be taking one drug to counter the side effects of the hRT (Mirena) - if that is indeed partly the cause of your symptoms.

Tibolone does not provide a very high oestrogen level, I understand.

Hope this helps and all the best.

Hurdity x

[Alex 2024]

Hi @hurdity and everyone else.

I spoke to my GP and as my previous oestrogen levels were 515 we've decided I'm going to try cutting down my Everol patch from 100 to 75.
Although this is still within a normal range it is "high-ish" so maybe this isn't a good amount for me? - in the past it has helped me when I cut down my oestrogen. I just thought that now I'm 2 years older it couldn't be this.
Fingers crossed it works...........!
Going to try that for 3 months and then maybe change progesterone.

Thanks for your help everyone - really helpful to consider things that I wouldn't have thought of.

Alex  x

[bombsh3ll]

If you are being asked to reduce your estrogen dose based on a blood test from 2 years ago when you may well still have been ovulating, and in the context of symptoms suggesting hypoestrogenism, it might be a good idea to re-test before doing so.

If this is based on a recent blood test fair enough, however the clinical picture should also be taken into consideration when reducing the dose.

It may be that your GP believes incorrectly that estrogen=bad and should be reduced or stopped at any opportunity, rather than making a holistic assessment and coming up with a shared and individualised treatment plan.

[Alex 2024]

Hi, it was from a recent blood test
My GP goes on symptoms... she actually hates numbers - it's me who likes them!!
Alex x