Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: anais on September 17, 2016, 01:10:01 AM
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It's been a while since I posted about my HRT regime.
My consultant at KCH increased my Estrogel to 3x doses per day. I was on Utrogestan 100mg and Vagifem on alternate days. I started to get light bleeds every 2 weeks for about 5 days on this regime so I had a TV-US scan. Lining was 2.9mm (2.4mm before HRT) and ovaries small, so the bleeding was put down to an imbalance in HRT regime.
At my most recent appointment the consultant recommended a Mirena coil as the best option so I had one fitted on Monday. Apart from the pain during the procedure and for the rest of the day and a some bleeding immediately afterwards, so far so good. (I think.)
I know it's early days. I've had some spotting but it's pretty minimal now. I haven't had sex either. Cramping hasn't been a problem after I recovered from the fitting. I can't tell if I can feel it or not. I'm prone to constipation and and that can cause a bit of achiness when I'm "full" so I can't tell, but no period-like pains, so perhaps it's business as usual.
Still on 3x Estrogel and 3.5 Vagifem per week. The consultant wants to prevent the bleeds otherwise he says I'd be repeating the scans every 6 months. He suggested Mirena as a better alternative to 200mg Utrogestan. There was another doctor sitting in with him that day and she came after me in the corridor when I left my appointment, saying she would fit it. She works locally in the sexual health clinic so it worked out pretty well. She was very good, I must say. She used a smaller size speculum which really helped too. I just hope it solves the bleeding problem. I've only had it in for 4 days but I know you need to give it time to know if it's going to suit you in the longer term.
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I had a Mirena, originally for heavy periods but after a few months as part of HRT with Climeval. It was great but for HRT purposes it's only used for 4 years so I had it taken out about 12 months ago. Since then my GP's have tried various regimes of pills, all of which have left me bleeding continuously :-\ Just over 2 weeks ago I stopped taking HRT( I'm 59 now) and am planning on giving it about 3 months to see how I feel. Whether or not I decide to go back on it I'm planning to change my GP. If I decide to go back on I will be asking for the Mirena and Climeval again.
A tip for having the coil put in or removed, or having smears if you find them painful, take a couple of ibuprofen before you go. I find that really helps.
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anais - I do hope the Mirena works well for you - it is popular with most gynaes as it often sorts problematic bleeding. I had one for 4 years post meno and used oestrogel alongside - it was so little hassle and after the first few weeks had no bleeding over the next 4 years (some bleeding and or spotting are normal for the first 3-6 months) . Sex was fine but I also used plenty of lubrication for sex. I just checked I could feel the strings now and again. I still used Sylk daily to help keep things moisturised around the lady bits. Keep using the Vagifem.
Good luck. DG x
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Stillsesrching, if only I knew to take painkillers BEFOREHAND! :D They actually injected a local anaesthetic into the cervix which was probably the most painful part of the procedure. The clinic gave me two paracetamol after the fitting and I had some Ibuprofen in the evening, and that was all I needed so I did better than I thought I would. Mind you, after I left the clinic I bought myself a bar of chocolate for the shock to the system, which helped enormously ;)
DG, I've had some spotting most days, but it's only day 5 with the Mirena and I suspect that my body has to adapt. I hope it does the trick because it was PMB that sparked off the referral to the meno clinic and being prescribed HRT although it was osteoporosis that was the main reason for systemic HRT. The bleeding has never really been resolved and increasing the Estrogel dose seemed to trigger these very light "periods" every two weeks, hence the Mirena. So I'm really hoping this does the trick but spotting for 3-6 months? Groan. It never ends! :(
The doctor who fitted the Mirena said to make a follow up appointment in 3-4 weeks to check all is OK so I can raise any issues when I see her. She works in the local Sexual Health clinics and they can do a lot more during an appointment. I think she mentioned something I can use externally for dryness but I was in a state of mild shock after the Mirena was fitted and anything else on my mind just evaporated. :o
Thanks for your replies. I'm hoping it works out, but I know that some love it and some hate it. I need to wait and see if it works for me.
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anais - some local oestrogen e.g. Vagifem, may be a good idea. Vaginal moisturisers/lubricants are also a good idea e.g. Sylk - I use Vagifem 2-3 times a week and Sylk every day. It will take 4-8 weeks at least for any bleeding and spotting to settle but I'm sure the Mirena could be your best option for controlling the bleeding.
Be patient. DG xxx
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Thanks, DG.
Well, my fortnight "breakthrough bleed" as they described it started right on cue on Sunday (day 6 of the Mirena), just as it would have happened if I was on the Utrogestan. I suppose it's because the Mirena has a cumulative effect. The amount of bleeding, a very light flow, is about the same as I would get on Utrogestan. It lasted around 5-6 days so I'd have a bleed free week or so and then it would start again. If the Mirena could stop these bleeds it would be ideal.
I had some mild discomfort on the day the bleeding started which I hadn't experienced with the Utrogestan, but I don't know if it was to do with the bleeding or whether it was my was my womb adjusting to the Mirena. Could be a bit of both. I needed to take Paracetamol twice but since then I've not really been aware of that very low abdominal ache.
The alternative was to take 200mg Utrogestan instead of 100mg but the consultant thought that the Mirena was the best option. I have to give it a try.
BTW, I'm on Vagifem which I use on alternate days. My practice nurse recommended aqueous cream to wash with and to apply if required. I don't use it as a moisturiser but it's a good alternative to soap or shower gel. The doctor who fitted my Mirena said she could give me something but in my "traumatised" state I forgot all about it! I will ask next time.
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anais - some spotting and bleeding on and off over the first few weeks after the Mirena is fitted is quite normal - this should settle and it is highly likely that you won't get any bleeding after about 3-4 months.
Sylk is a good vaginal moisturiser - I use it every day after the shower - a small amount goes a long way.
It is also normal to get some cramping in the early weeks. DG x
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I've now had the Mirena for 2 1/2 weeks and I've had some bleeding every day, which I suppose is "normal" but it's more than I was getting on Utrogestan 100mg. Not in terms of volume but at least on Utrogestan I'd have had at least a few days without bleeding.
Besides the bleeding I started having pain on one side and during sex at the point of orgasm I experienced what felt like a sharp, thick knitting needle stabbing into my groin. The previous week I'd had sex and wasn't aware of the Mirena at all.
So after that I was aware of this grumbling pain on one side for the following few days, but not as intensely as the sex/orgasm experience. I made an appointment at the local sexual health clinic yesterday and they assured me its in place and it's just my body adapting. Obviously the strings are visible etc, so they feel confident all is well.
They actually explained that they tell their patients that the first 6 months (!!) of having a Mirena can be difficult – pain, irregular bleeding, etc. Well..... doesn't exactly inspire confidence, does it?
I've made an appointment at the clinic where I had it fitted for next week anyway. I was told I needed to go back to have it checked 3-4 weeks after fitting so I'll stick with that appointment, and besides its better to be reassured than not.
So that's the story so far – bleeding everyday from spotting to a light flow; pain during sex on one side; and a grumbling low grade pain on the same side over the following days, and possibly beginning a day or two before I had sex. I'm told all is well with the Mirena from a medical point of view. I'm having a follow up appointment next week.
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anais - What you are experiencing is all quite normal - the sexual health clinic are quite right but for most women things settles within the first 3 months. I'm afraid you need to be patient. The point is that, for some women, Utrogestan is not good at controlling bleeds so ongoing breakthrough bleeding problems are more likely to happen - once things settle on the Mirena you will hopefully get 4 years of HRT without the bleeding. Try not to worry and try to be positive. DG x
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I got cramping and odd feelings for nearly three weeks after my mirena was fitted, but it settled and I haven't had any discomfort since.
I also had daily, albeit very light spotting for 4.5 months.
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Last night I was in agony, like being stabbed on the inside with a knitting needle. I had waves of these stabbing pains on one side. I couldn't sleep with the pain. It was nothing like menstrual cramping. I took ibuprofen and codeine, which did nothing. I'm bleeding heavier today. It's not spotting, it's more like a period. I've been in pain all day. More ibuprofen and codeine this evening which hardly touched the pain. Its still all on on side. Same place. It's getting me down big time. I have an appointment the day after tomorrow. I'm sure this isn't normal. It's over 3 weeks since I had it put in and the pain is worse than it was a week ago. I can't honestly be expected to endure this for 3 months, or 6 monhs, not if I'm in agony all day and can't sleep at night. If heavy duty painkillers don't work then I don't think this can be normal.
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I no of ladies from other forums , were it was stuck in the uterus wall and had to be removed , they had to demand a MRI / scan can't remember which to have it confirmed and then removed.
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Anais - To get some proper bleeding is normal at around 3 weeks post fitting but to be in this sort of pain 3 weeks on isn't right. However, I do believe there is an initial hit of progesterone in the first few weeks and perhaps this is encouraging a good ‘clear out'. Strange that it is just on one side - I think this needs to be checked out so do pop to the GP - might be something else causing the pain but you need reassurance anyway.
Over the 4 years I had the Mirena I did get the occasional bout of cramping but it was often a bit of upset tummy or trapped wind. I suspect your uterus may be responding to the progesterone and this should settle.
Keep us posted. DG x
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I have no experience of Mirena - but from what you have said I would definitely go for same day appointment with the doctor - that's not the sort of thing that should wait if you are in agony and the pain is not relieved by the strong painkillers that you are taking. If you still have it today (severe pain not relieved by painkillers) please go tomorrow and don't wait another day or phone NHS direct if it's that bad...if it has subsided then fine to wait until your appt the day after I presume.
Hurdity x
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Thanks for your replies. I was definitely worried. The pain subsided and then bizarrely I came down with flu like symptoms so yes, I was beginning to worry at that stage. Anyway, I had to cancel my follow up because of the flu-like viral symptoms but then pain stopped. I've gone from miserable agony to being completely unaware of the Mirena's presence.
I went to my appointment last week and I was told all was well, she did a swab for infection and that was clear, as expected. She looked at my bleeding pattern and said it was typical for first few weeks of the Mirena.
Over the past 7-10 days the bleeding has been lighter. A couple of days here and there it was very scant but overall it seems lighter but then I'm sort of prepared for unpredictability at least for a while. ive had sex twice since the pain has stopped and I wasn't aware of the Mirena at all.
So, I still have the Mirena. The pain is much improved and I hope it stays that way. The bleeding hasn't stopped but it's fairly light spotting at the moment. I'm expecting some degree of unpredictability with pain/physical discomfort and bleeding. So far there's improvement on both those aspects, so I will persevered for the noo.
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Good to hear you are doing well anais. The bleeding and spotting may continue on and off for a few weeks more and this is quite normal. Some do get the odd bleed or spotting generally with the Mirena but usually once the progesterone in the Mirena has calmed the womb lining right down this seldom happens.
The Mirena can be the simplest option for HRT and it is not uncommon to get some slight sedative effects in the first few months as well - I slept like a baby in the first 6 months. A high percentage of women do extremely well with the Mirena and this is why it is so often recommended by gynaes. Keep well. DG x
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Just another update even though I started this topic in September.
The bleeding became progressively lighter, to light spotting after several weeks and then to minimal spotting with a one-off day here and there with no visible signs of spotting. So, just when I thought that the bleeding had stopped... the spotting started up again. Only light spotting for a few days, and then followed by about 10 days of nothing at all at around the three months point.
So that was great, the Mirena was doing it's job as expected. And then today and yesterday - spotting again. :(
Perhaps, as you say Dancing Girl, a wee bit of spotting now and then is within the normal expectations of using the Mirena. I've been keeping a record on the printed calendar on the back of the Mirena information booklet and I'm seeing the consultant at KCH next month. I have a few more weeks to observe and record any bleeding and spotting which I will then take to my appointment.
So, at about the three months the bleeding/spotting stopped but after 10-12 days a wee bit of spotting has appeared. I was getting breakthrough bleeding oncontinuous Utrogestan and was having a light bleed every 12-14 days for about 5 days. I have the option of 200mg Utrogestan daily but after going through all of this rigmarole of the Mirena, I'm more inclined to stick with it.
BTW, I had no improvement in sleep with the Mirena, nor did I have better sleep on Utrogestan. I have ME/CFS and my sleep pattern was disturbed anyway. My consultant says it only really helps sleep problems if they are caused by the hormone changes associated with the menopause so he warned me it probably wouldn't help in my case, and he was right.
I was a bit annoyed with the info on Dr Studd's website saying that HRT can help with CFS/ME. That's misleading. It can only address the problems associated with the menopause. If otherwise healthy women experience tiredness at the menopause that probably can be helped by HRT but there's a world of difference between that and someone with ME/CFS. HRT hasn't helped my ME symptoms one jot, but it's probably one of those situations where "your mileage may vary". I'm saying this for the benefit of other women with ME/CFS, not as a criticism of anyone here who genuinely wants to help people. I'm taking HRT because of osteoporosis not because of classic menopause symptoms so for me it's all about what the DEXA scan looks like rather than how I feel symptom-wise.
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anais - so pleased to hear things are settling well. Spotting now and again is quite normal with the Mirena and is rarely anything to worry about - only if it becomes heavy should one get things checked.
I do agree with you about HRT not necessarily helping other health conditions - sometimes it can help by reducing the meno symptoms but I don't think we can expect HRT to be a cure-all. In time, together with other strategies, your CFS/ME may improve 'a bit' because meno symptoms are more controlled. I assume you engage the usual strategies to help improve sleep e.g. good bed time routine, darkened room etc.
If you want to treat or prevent bone loss then you are doing the right thing. Do keep us posted about your ongoing progress - there are so many women who are scared to try the Mirena and it can be a very good option as part of HRT. DG xxxxx
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Hi Anais interesting post, I'm booked in for a mirena fitting on the 5th Jan (I'm currently on utrogestan) and am hoping I've made the right decision. My main concerns are whether it makes me depressed or affects libido/response. Have you noticed any difference in any of these issues?
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Hi peri
I had mirena fitted in September and I was absolutely terrified it would make my mood and pms worse however its been the exact opposite I haven't had much pms and what I have had has been tiny compared to before
The only issue I have had with it is heavy periods lasting up to two weeks with a break of a few days before the next one starts but id rather live with that than severe pms
Xx
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That's comforting to know walkingthedog, thanks for that. Unbearable pmt has been my worst symptom, I can cope with anything else if my mood is even x
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The thing about CFS/ME that some of us are concerned about, is for women to be wary of being diagnosed with conditions like this for the first time when you reach or approach menopause - in lieu of a proper endocrine screening and treatment. We have seen that women are "threatened" with these diagnoses including myself - fibromyalgia was suggested to me for my persistent aches and pains and tiredness, and the doc was going to refer me on - and some of these women have in fact not had these conditions but some sort of hormone deficiency - whether it be oestrogen, testosterone or underactive thyroid. Unfortunately the docs don't often see a holistic picture - testosterone is not routinely considered, and many women experience symptoms due to mildly underactive thryoid ( but within normal, untreatable range), and low oestrogen levels are considered normal for post-menopause so in the absence of flushes and sweats would not necessarily be treated with HRT.
Those who already have these unfortunate conditions that are not due to any hormone disturbance as Dancinggirl says - may not see an improvement - although some women do report their symptoms abate somewhat with HRT.
I hope you see an improvement soon anais.
Hurdity x
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Hi everyone, thanks for all your responses, so I'll give you all an update.
I'm 6 1/2 months with the Mirena now and I've had no spotting for an entire month. So perhaps I've finally got there, but it took 5 1/2 months to get there.
I saw the consultant at KCH on 25 January. He was happy that the bleeding had stopped even if some light/minimal spotting started up again. After a couple of weeks the spotting stopped for maybe another 10 days or so. He was happy enough with that. He said just stick with the Mirena until my next review. If the spotting continues he said I could take Utrogestan in addition to the Mirena.
So, after some very light/minimal on/off spotting throughout February - sometimes just a tiny trace - I've been bleed-free for the past 4-5 weeks, no spotting. So far so good. I see the consultant again at the beginning of August for review.
I was also prescribed Ovestin to help a bit with the outside bits as I have been prone to dryness and soreness. It helps just a wee bit but nothing dramatic.
My current HRT regime is 3x doses of Estrogel daily, Vagifem on alternate days and Ovestin 3x weekly, and the Mirena of course.
Peri, the Mirena didn't really have any mood changes for me and sadly not much difference in libido or response either. I have hoped all along that each thing I try might restore some of that lost lustiness of my former self but sadly not. The HRT has definitely helped in that regard but emotional issues have far more of a dampening effect on my libido than they would have done pre menopause. Even relatively trivial issues. The only thing left to try is testosterone but I've had to get the bleeding sorted before I can even think about yet another change in my HRT regime.
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Thanks for the update anais - very helpful to Mirena users :)
Hope you continue to see an improvement.
Hurdity x
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Would you believe it, I've had spotting today. First time in 5 weeks. Somewhat disappointing but I'm keeping a diary. I don't know if odd spotting now and again is to be expected on systemic HRT with a Mirena. I was scanned last August because the bleeding and spotting wouldn't settle on Utrogestan, hence the Mirena. Lining was 2.9mm and ovaries were small, so the docs were happy enough to diagnose 'breakthrough bleeding'. Not sure if I want Utrogestan on top of the Mirena but after all I went through after the fitting, the pain during weeks 2-4 and the constant bleeding that settled into constant spotting, then intermittent spotting, then none... until today. Grrrrr.
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Anais - if you read the info about the Mirena onthis site, it clearly states that not all women are completely bleed free when using the Mirena. You are using quite a high dose of oestrogen so maybe you are more likely to get a bit of spotting now and again. I had the Mirena for 4 years and occasionally got a bit of spotting. Try to relax - you're feeling better overall so this combo sounds good for you. There are no quick fixes. DG x
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Thanks DG. :)
I can accept the odd few days of spotting here and there. It's just after the "miracle" of being bleed free for several weeks it's a case of "oh, THAT again..." <groan> :-\
At least I'm seen by a very good consultant at KCH. Anything that seems a bit atypical will be checked out. However, he did say that bleeding after the menopause isn't normal so if I'm having any bleeding it's impossible to know if it's breakthrough bleeding or a medical issue, hence why I had another ultrasound last August. So that's why he said give it a few more months and if it's still ongoing I could stick with the Mirena AND take Utrogestan. Like most women on here I don't want to be a walking pharmacy if I can help so I'd prefer it if the Mirena can do it without adding more into the mix.
The consultant was optimistic because the bleeding and spotting had actually stopped for a couple of stretches of about 9-10 days in December and January. February had more bleed free days than January, but I had no bleeding in March. I was feeling happy because I thought it was problem solved. Maybe. Let's see. My next review is in early August.