Menopause Matters Forum
Menopause Discussion => All things menopause => Topic started by: Mindfulmoomins on November 28, 2017, 09:53:43 AM
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Hi,
After a bad reaction to Evorel Sequi (anxiety, jitters, IBS, off work due to symptoms) my GP is suggesting the Mirena Coil and Estrogel.
I am slightly terrrified about having something inside me that releases progesterone as it might be the norehistine in Evorel Sequi that is causing my current issues (particularly anxiety).
I would really love to hear from anyone who has tried the Mirena and Estrogel (thanks already to DG for sharing her experience). There are lots of threads about the Mirena online which seem to suggest the Mirena can cause depression. My Gp says the research does not back this up.
Thank you so much.
NB I have had anxiety before and depression (always managed with various tools, medication and therapy) and was having some of those symptoms before going on to HRT. At first the HRT helped and I felt a bit more like my normal self. Then after 2 months anxiety started and built becoming severe. I exercise, meditate and have good support.
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The progestogen released by the Mirena is also used in FemSeven patches (Sequi/Conti), so if you have not tried these & are understandably wary of having a Mirena fitted, you could perhaps try FemSeven Sequi as an easily removable alterntative to the Evorel.
That said, the two (FemSeven & Mirena) may not be comparable in terms of systemic effects - there are generally said to be fewer from the Mirena - so you may feel worse on the likely bigger hit of levonorgestrel from the patch than you might from the IUD.
Have not used the Mirena myself, as I got on badly with the Levonorgestrel phase of the FemSeven sequi patches, so didn't want to risk it. Hopefully you will get plenty of replies from women who have used the combination your GP is suggesting & those who have felt fine on the Mirena.
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Thank you Wrensong, that's really helpful. Can I ask whether you found something that worked for you HRT wise? Thank you.
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I had the Mirena fitted a year ago and use with 3 pumps of estrogel, for me personally I am getting on really well with this combo. I tried Utrogestan and Cyclogest progesterone before this with horrendous side effects.
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I had a Mirena fitted 18 months ago and use three pumps of Estrogel with it.
Apart from the initial spotting that went on for 4.5 months I have had no problems with it, hopefully that will continue and I will get another when it comes up for renewal.
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Thank you Abbafan and Tinkerbell. The online stories are mostly about people using it for contraception and I imagine it's a different experience using it for perimenopause.
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Hi Mindfulmoomins - please don't be put off by what I'm going to say as we are all different in the way we respond to medication & there is every chance you will find a regime to suit you well.
In answer to your question, I'm afraid I didn't find a regime I could tolerate that resolved my symptoms completely, but my situation is a bit more complicated as I'm also hypothyroid & a funny patient at that, as I need a combination of thyroid hormones, not just thyroxine to manage my thyroid condition.
I've been on Evorel Conti for 2+ years but didn't start HRT until 3 years post-meno as my mother died of breast cancer, so I'd been trying to avoid using it. My menopause symptoms were severe & went on for more than a decade before I finally decided enough was enough. My oestradiol level pre-HRT was found to be too low to measure, so I took advice from a top Endocrinologist & a Gynae specialising in HRT & both felt starting it would be right for me, regardless of family history.
As I only got partial symptom relief from Evorel Conti, I tried a number of other regimes, but the side effects were too bad to continue, though I suspect this may have been partly due to interaction with my thyroid medication, as the two have to be fine tuned. I returned to the Evorel after each failed trial as I did feel better on this than without HRT.
A few months ago my oestradiol was finally tested for the first time since starting HRT & showed poor absorption - at only half the level expected for a 50mcg patch, explaining the poor symptom control. We were hoping via further trial & error to eventually find a regime that would give full symptom relief, but there has recently been a change in family history that makes me uncertain whether it's sensible to continue & the medics whose advice I've sought have differed in opinion! So I've now been cutting down my patch for 6 weeks with a view to seeing how I am without HRT. If symptoms return at full strength, I will probably go back on HRT & at that point genetic advice will be sought. It has been a difficult decision as I now also have osteopenia & the HRT was my only treatment for that.
I understand completely what a worrying time it can be when you are new to HRT & would just say that it can take a little while to find the regime that is right for you, but it is worth persevering. Many women get on well with the Mirena & using gel allows flexibility with the oestrogen dose. If you decide you really don't want to opt for a Mirena at this stage & want to keep to transdermal oestrogen, the FemSeven patches are an option, as well as using an oestrogen only patch or the gel with Utrogestan capsules (used orally or vaginally).
I'm assuming the Evorel is all you've tried so far, but I don't know your history, so apologies if this is not so. I expect you will get more replies & there is plenty of info on the site if you have a dig around, to help you feel more confident in taking the next step. Take your time so that you are comfortable with what you decide & bear in mind that if the next regime isn't right for you, there will still be others you can try. Please never be afraid to ask questions - we all just want to help & there is always someone here for moral support. :)
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Wrensong, your message has really touched me. Thank you so much for your encouragement and honesty. Very best of luck with reducing your HRT. Xx
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Hi Mindfulmoomins
Just to say I agree that Femseven would be a good one to try because of the same progestogen as Mirnea - but also to say that systemic asborption is approx in the same ball park for the two. The Mirena was originally developed for contraception and so the comparison re systemic effects is made with an oral CCP (or POP?) containing the same progestogen - and the Mirena is much less. Used as HRT then I looked up from the data given for the products and for Mirena max absoprtion is in the first few months and gradually declines over the 5 years - but I think initially it was similar to Femseven ( can't remember exactly at what point in the 5 years) - but like all progestogens the response is highly variable amongst different women.
As has been said the beauty of the Mirena is that you can adjust the oestrogen dose to suit you which you can't do in a combi patch.
Hurdity x
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Thanks Hurdity, all this is very useful as I am speaking to my GP again today.
I've just read that Norehistine should be used with caution by people with a history of depression (me) and that suicidal thoughts, an irregular heartbeat and gastri problems are possible side effects.
These are definite side effects for me and although I don't feel suicidal I have moments where I feel such despair. I wait for them to pass but they are horrid.
X
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Mindfulmoomins - you're very welcome. Thank you for the kind wishes. Good luck with the GP today! Let us know how you get on.
Hurdity - I was hoping you would see this thread! Thank you for the info on levels of prog from Mirena v Femseven. I'd half remembered a post of yours from a few months back referring to research that seemed to change what we'd previously thought about Mirena's progesterone hit, but couldn't recall the detail, so it's really helpful to have this here. Wx
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Hi Mindfulmoomins, I got the mirena coil fitted about 2 years ago as I was at my wits end with heavy periods and insomnia (didn't need it for contraception).
Can't deny, my mood did feel a bit flat initially but improved after the first 6 months......as my body got used to it, I suppose.
I don't seem to need oestrogel yet but do have Vagifem for VA. Am 51 & no idea if I'm still peri or not!
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Hi everyone,
So my GP has spoken to a colleague in a menopause clinic and they have suggested that due to my mood related problems since perimenopause and on Evorel Sequi 50 the best thing to try would be estrogel and ultragestan orally.
I am due to pick up the prescription today and I'll give it a try for 6 weeks (as long as I don't have unbearable side effects).
This is going to sound silly but I am worried it's not the HRT (norehistine) causing all these side effects. As in it's me having some sort of episode or my peri hormones going crazy!
Rationally I know it might be multi-factoral (the HRT, my underlying peri hormones and my history).
I guess I just don't know what I'll do if this next regime doesn't work.
Actually I do know, I'll come on here for support and advice.
I am finding all of this really really tough and just want my life back.
I am lucky to have good support and this site is brilliant. I asked the Gp if I could access any counselling but the council has run out of money and they are not allowed to refer anyone. Seems fairly crazy to me not to have a budget for that sort of thing but I know the NHS is struggling.
Anyway, as always the encouragement and support I get on here means a lot.
X
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Thank you Elsie001. Good to have your feedback.
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Hello Mindfulmoomins.
I think many of us worry that our difficulties are due to more than just hormonal havoc but your comment about wanting your life back is often used by other women on the forum and indicates that we were all jogging along nicely before our ovaries died on us! I was thinking today that I was totally unprepared for the horrible meno symptoms but then again how could I have prepared for something that I hadn't experienced? It's hard to have a strategy to deal with something that has never happened.
I also understand your nervousness about your new regime, again we all worry about feeling worse, all I can say is give it a try and we are here to hold your hand if you need us.
It is a shame about the lack of funds for counselling, it all comes down to money and despite political statements and media soundbites it's clear that many health services are not adequately resourced.
Take care and let us know how you get on.
K.
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Hello Mindfulmoomins
I just wanted to tell you that I also get horrible anxiety when on progesterone - have tried utrogestan and levonorgestrel and both had this effect, but not until a couple of months in, I think it takes that long to build up in your system and start causing problems. I also share your worries about whether the mood stuff is hormonal rather than 'just' depression as I've also suffered from this before, but the more I find out about menopause and HRT the more I'm convinced that, for me, it is down to hormones. Estrogen has definitely had a positive effect on my mood, now like you I have to find a solution to the progesterone problem...the best advice I can give you is find someone who really knows what they're talking about to advise you, cos it's mind-blowingly complicated! x
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Kathleen and Racjen, thank you. It is so good to know I am not alone in this. I think I am going to ask for a referral to a menopause clinic as this stuff is all very complicated.
I almost wish I could meet some of you as your kindness and support is so valuable.
A friend of mine's sister set up ‘menopause cafes' in Scotland which have proved very popular I believe! Sounds like a wonderful idea.
X
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I ended up going private, much against my principles and can't really afford it, but there's no longer an NHS menopause clinic in Devon/Cornwall and couldn't face the wait to see anyone else. Glad I did as otherwise I'd be struggling with antidepressants and CBT now - useless in this situation I think. Makes me so cross >:( Menopause cafes sound a great idea - will think on that x
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Hi again Mindfulmoomins
Great news that your GP has consulted a menopause clinic without your having to wait for a referral which can take time!
Try not to anticipate problems! Yes your hormones are going haywire because of peri-menopause and yes norethisterone can cause pms type symptoms in some women and yes progesterone itself can also cause side effects in some women. The most important thing is that you end up feeling better overall on HRT than off it.
Also did you read the article on perimenopause - I often refer new members to it - very helpful: https://www.menopausematters.co.uk/magazine/pdf/Article%20-%20Perils%20of%20the%20Perimenopause.pdf
Interesting about the menopause cafe. Might I suggest you start a new thread on this - does the menopause cafe have a website or Facebook page or is it attached to a particular surgery or town? I am sure that other members reading on here who live in those areas in Scotland might find it useful and their attention will be drawn to it if there is a separate posting. Don't give out any personal information but a link if there is one would be helpful! There was a former member on here - Tempest who wanted to get a Meet-up group going through this website but it was difficult to get off the ground - and of course has to be done by firstly asking and then by pm - if members are interested. It's such a great idea and women often say something along the lines - "if I lived nearer I would love to meet up for a coffee ..." etc).
Anyway I do hope that this new regime makes you feel better overall and please let us know how you get on.
Hurdity x
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Thanks Hurdity,
I will ask my friend more about the menopause cafe and find out if there are any links I could post.
I most definitely have not felt better on Evorel Sequi 50 (although I did in the first month). I am currently not at work due to my symptoms and was always able to work before.
I am just praying that some of the current symptoms recede so I can manage and feel better. I also hope the new regime of estrogel and utrogestan works better.
I just want some quality if life back.
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Hi Mindfulmoomins, I hope the Utrogestan works for you. It seems to be love it or hate it t make me groggy and it did lower my mood. I switched and tried provera, which didn't make me groggy, or lower my mood. It didn't work for me as it made my hair shed, but it may work for you if the Utrogestan doesn't. There's lots of other options :)
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So I have been given estrogel 1 pump and ultrogestan tablets by my GP who spoke to a colleague who works in a menopause clinic. I am really hoping I can tolerate the latter.
The label on the ultrogestan says ‘insert two at night for last two weeks of month'. The GP specifically said they were for oral use (as in not licensed for that in this country although lots of women use them that way) so I am confused about how many to take orally.
I'll try and get hold of her again but can anyone help with the usual oral dose of utrogestan (and on what days) with one pump of Estrogel?
I would also just like to say a huge thank you to everyone on this forum and especially those that responded. It helped me so much as this has really been a tough couple of months.
I will be back here when I am taking the utrogestan in a week or so no doubt and might need my hand held a bit after my experience with norehistine! Obviously I am trying not to project but I am nervous.
X
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Hi Mindfulmoomins
re the label - did you specifically ask for vaginal progesterone and are you in UK? If your GP has prescribed it like this then that's great - but it's off licence. However research shows that MORE not LESS progesterone gets to the uterus when used vaginally compared the equivalent dose taken orally so just go ahead as instructed. The instructions for vaginal application on the printed material will usually only be with the 200 mg caspules used for fertility.
The licensed oral dose is the same as for vaginal - 200 mg for 12 days - and this is what you should start with (although personally I have never taken it orally - being nil-by-mouth when it comes to HRT!). Two weeks is not necessary as you will see here: https://www.menopausematters.co.uk/to_progestogens.php unless eg you have had problems with bleeding or fiborids etc which means that doc wants you to take a full two weeks?
Once you know how your uterus behaves under this regime you may be able to work with your doc to reduce the dose somewhat or lengthen your cycle (if you are post-menopausal or nearly so).
Good luck, try not to be nervous, don't anticipate problems and let us know how you get on :)
Hurdity x