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[VerityDreamer]

Hello,
I have been reading here recently - I am 45 and recently had the Mirena Coil removed after 5 years.  - I did  not have any bleeding at all in those 5 years on the coil and now, 2 1/2 months after removal I still haven't had any bleeding but I'm having terrible peri-meno syptoms. 

I had tried progresterone cream which I bought online and that helped but it caused me to have hot flushes and other side effects so I stopped it.  I bought some estriol cream and tried it starting Sunday but can't see any change.

I'm having lots of hot flushes, mood swings, and sweating.  I am going to see a consultant here in the UK privately but I wonder if it is worth the money?  I have an appt with my GP also in the works but I think she will just put me on Eostrogen therapy and in the past, even small doses of estrogen (from BCPs) caused me weight gain and anxiety.

I felt so much better at first without the coil and with the progesterone cream - it really helped my anxiety and sleep but then I started getting the hot flushes and other symptoms. 

Anyone know of anything that I should try on my own or that I could specifically ask my GP to prescribe me? 

Thanks for any advice. 

[Hurdity]

Hi VerityDreamer

 

I am not familiar with how long it might take for periods to come back after removal of Mirena if you are peri-menopausal - or even if you are not! However if you are getting hot flushes and without a period for two months and at your age this does indicate that you are peri-menopausal. If this is the case then your oestrogen levels are beginning to decline and HRT should help your symptoms.

The oestrogen from the BCPs is totally different from HRT - the former is strong and synthetic and the BCP's also contain high doses of synthetic progestogen. If the Mirena suited you, then why not ask for another one to be fitted - then it would also deal with contraception as well as providing the progestogen part of HRT? You can then add in oestrogen starting with small doses until you felt well. I would suggest transdermal oestrogen (through the skin) because that gets into the system quicker, doesn't have to be digested nor go through the liver. You can use patches or gel according to preference - I have just mentioned these to another new member. Oestrogen gel is applied once or twice a day, and patches applied twice a week.

Progesterone cream cannot help symptoms caused by reduced oestrogen, and nor can it protect the womb from over-thickening due to added oestrogen!

Personally I don't see the need to go privately - given that the above is all available on NHS and is your right if you want it and have no medical reason why not. However you would need to make sure you know what you want and why, that your GP (or another in your practice) is sympathetic to women in menopause and understands/will prescribe HRT - as there have been too many cases of women being fobbed off!

Hope this helps - do ask if you need any more info!

Hurdity x

[dahliagirl]

Hi - it took 5 months for my periods to come back after stopping hormonal BC.  They used to come back straight away before peri-menopause.  Then I had loads. 

If that happens, it is definitely worth considering another Mirena and oestrogen to stop any meno symptoms.  I didn't because I was scared of them - sort of regret that now 

[Dawncam]

Hi Dahliagirl and welcome.

As other ladies have mentioned, if you get on with Mirena then it's an easy and convenient way to deal with progesterone part of HRT. I don't get on with coils but if I did I'd have one. I've tried both oestrogel and oestrogen patches and have settled on patches.

I eventually went to a private gynae but as Hurdity says, there's no need to if you know what you want. I didn't, but do now. Transdermal oestrogen is probably the safest route for that part of HRT and if you don't agree with Mirena anymore, most consultant gynaes recommend utrogestan as a progesterone as its identical to our own progesterone.

Dig around on this sight and you'll find lots of experiences from women similar to you. Get all your ducks in a row and go to your GP. It'll save you a lot of money if you can get what you need from GP. The only 'extra' I got from private was a bone scan. You can have your bloods done at GP.

Hope this helps and good luck.

Dxx

[VerityDreamer]

Hi,
Thank you so much for the replies!  So helpful.  I have read a lot here and see that most say that researching for yourself is the best thing to do so I set out to research for myself and ended up very confused but now have these recommendations here so thank you for that.  I will ask for those from my GP in the first instance.   

The Mirena did not suit me in many ways - I had a lot of problems with it - it caused me terrible bladder leak problems, bowel problems (sorry!) and weight gain, I am not keen to have it again at all however the GP was very very keen to replace my Mirena with another one. 

Maybe my bleeding will return if I wait longer.

These hot flushes were terrible yesterday - I must have had 10 of them during the day and am now sweating which is awful when it happens during the day time. 

I am seeing Mr. Dooley - I have read here that some consultants use a standard protocol for all patients - does anyone know if he does?  I can't see a point in going if a consultant uses a standard protocol but maybe that is me misunderstanding the therapy. 

I am also in the area for referral for Panay on the NHS but doubt very seriously that my GP would refer me until they have tried me on their regular protocol. I don't have a GP anymore that will work with me re the prescriptions but I guess I could try going in and asking for the gel as you've recommended and hope that she is amenable.   

That's good news re the eostrogen in the BCP vs HRT being different - that may mean that I can tolerate it - very good news. 

I'm confused though - re the blood tests - I didn't think they were very useful and that treatment is symptom based?  Why would I request a blood test? 

Also, please tell me that this mood swings/low mood are part of it?  I haven't been so tearful/weepy and low mood (for no reason so at least I can rationalise that it is hormonal as I am actually in a good time in my life right now). 

Thank you so much for the help.  I am sweating profusely as I type.  So lovely.   

[Dawncam]

Sorry Dahliagirl - used your name instead of postees! New to this, apologies.

Dx

[Dancinggirl]

Hi and welcome to MM VerityDreamer
You have had some good advice so far but I would like to add my thoughts. 
As Hurdity has already pointed out, BCPs are different to HRT so you mustn't look for problems when you try HRT. Most HRTs have bio identical oestrogen so works with your body far better that anything in a BCP.

It does sound as though you are peri meno and this is not unusual for mid 40s and this phase can last some years with the hormone levels fluctuating, periods coming and going in an erratic way and causing low mood, flushes etc. - it is staggering how these fluctuations can play havoc with our emotions.

You will read very mixed experiences and advice on this site and many are well informed but you must never assume that what works for one person will work for you. The menopause is a confusing and worrying time for many - nobody warns you about what can happen - but we are here to help.  Do read up all the info on this site to get really clued up.

Blood tests can be useful as the FHS level can be a good indicator of whether you are entering menopause - although oestrogen and even FHS can fluctuate during peri meno.

You shouldn't need to go privately as your GP should be your first port of call.  Try to find out which doctor at your practise specialises or has some knowledge of treatment for the meno first - make an appointment and go prepared. Write down your symptoms and questions, be clear about why you want to try HRT (if you do) and the type do HRT you would like to try.
If you look under TREATMENTS above under Perimenopause, you will see your HRT options - do take a print out with you when you see the GP.  I have tried almost every HRT under the sun as I had a premature menopause and needed HRt for over 20 years.  It does take some trial and error before finding the one that suits you but I would suggest you try Femoston 1/10 first as this is tolerated very well by many women.  GPs usually prescribe Elleste Duet as it is the cheapest but Elleste has a progesterone that sometimes gives more PMT type symptoms.
I do think private gyneas can vary in the way they treat menopause but if you go armed with the right information and questions then you can usually get the better outcome. However I would let your GP try you on an HRT first before seeking advice privately  - you may get a GP who is sympathetic and is prepared to find you something that works.
Keep us posted  DG xxx

[Hurdity]

Hi again

Just to add re blood tests that your doc should just go on your age and symptoms - according to the new NICE Guidelines - because as Dancinggirl says FSH is an unreliable indicator, although some docs like to test for it. It's a good idea to have general blood tests though when first going to docs with symptoms - to rule out other conditions eg thyroid problems which can cause overlapping symptoms eg sweats - so if you haven't had any bloods done recently I would hope your doc would do them for this reason - but not just to diagnose menopause.

If your GP or another in the practice will not consider the HRT that you decide you would like to try then I would insist on a referral (that might make them prescribe!) - and great that Nick Panay is in your area as he practises on NHS and is one of the top gynaes. I have also heard good reports of Mr Dooley as I know someone (on another forum) who has been to him for years. However as we have advised - do try your own GP practice first.

Hurdity x

[VerityDreamer]

Ok, thank you so much for the replies.  They are very helpful.  I will see if it is too late to cancel my appointment and just try on the NHS. 

Will also do as you've suggested re reading up on the information that you've given me. 

Thank you so much, I can't thank you enough.   

[Dawncam]

Hi VerityDreamer

Apologies I didn't mean to confuse you re. Blood tests, just wanted to point out that other than bone scan, that was all I got at my private gynae. I have to say though that the bone scan was revealing and indicated that hrt was defo a good idea for me. The bloods, as others have pointed out, were for EVERYTHING - very thorough, not just peri/meno hormone levels and they did highlight that I had virtually no testosterone.

It's really up to you which way to go re. Nhs/private - do more research and make your own informed choice. Everyone's experience is different.

Good luck and keep us posted on your progress.

Dx

[VerityDreamer]

Hello -
Thanks for the advice here - I ended up going to both GP and consultant privately.  I've paid for bone scan and ultrasound just to make sure that nothing was wrong. 

Blood tests also ordered to see if I do have reduced FHS levels. 

My GP was not amenable to starting HT now - she ordered FSH levels to be tested now and in 6 weeks.  Based on the results she will prescribe (or not prescribe) hormones.  She wasn't interested in giving me a bone scan or a trans-vaginal ultrasound.    And she didn't seem to care that I am having horrendous symptoms and that 6 weeks feels like an eternity without some relief.

I am working hard to change diet and exercise lots and get sleep, etc to the best state.

Will go back to the consultant on Thursday to get prescription - Oestrogel & progesterone.  Does this sound like a good place to start? 

I am wondering if anyone saw relief straight away?!  My moods and irritability are now trumping the hot flushes and sweating and that's saying something!  I am really struggling to control my anger and irritability and I have never been like this before. 

I have read up and researched more but one thing I don't understand is where the mood swings come from - if oestrogen is declining, why the ups and downs and such terrible irritability - (I see from reading here that I am not alone.)

Thanks!

[VerityDreamer]

Also - my GP will clearly not be amenable to working with me on what suits me re hormones - she insists that I need a new Mirena coil and some eostrogen tablets - when I asked about the gel she said that that was not what I would need but that we could talk about it later after bloods come back.   

[Mary G]

VerityDreamer, I would stick with the advice of your specialist and Oestrogel and progesterone sounds like a very good place to start.  What type of progesterone did he prescribe?  I found my symptoms disappeared very quickly on this regime.

From what you have said, you didn't do particularly well with the Mirena coil so I would advise caution.  If you get on well with the Mirena coil then fine, it is a good option for the progesterone part of HRT but if you have suffered with any changes in mood, breast pain, headaches or migraines in the past while using it then it is probably better to look at other options.  In theory, the progesterone in the Mirena is mostly confined to the womb but enough of it gets into your overall system to cause side effects.

I don't know what you GP meant by suggesting you don't need Oestrogel.  From my own experience, the gel works far better than oral oestrogen and it is always better not to ingest the stuff and process it via your liver.  This is the problem that so many women have, GPs are not HRT specialists and it is a bit hit and miss and to what you end up getting.  They will often guide you towards a Mirena coil and/or oral HRT because it is easy (and cheaper) but it is not necessarily right for you. 

[VerityDreamer]

Thank you, Mary - I'm so glad to hear that your symptoms went away quickly with hormone therapy - you have made my weekend!  I hope I feel better once I get the prescription. 

He didn't say which type of progesterone - he is waiting for blood test results, etc to come back, he just said 'progesterone'. 

The coil didn't suit me but I do worry that oral progesterone might not be great either but hopefully if it's balanced out with some oestrogen it will be better. 

Thank you for replying. 

[Mary G]

I'm glad you feel optimistic and you have every reason to, I found the gel to be the most effective form of oestrogen by far and it is also very flexible because you can adjust the dose to suit your needs. 

Re the progesterone, he might prescribe Utrogestan which is better used vaginally because it hits the spot.  It is better not to ingest progesterone if you don't have to and it works better at clearance/thinning when used in this way.  It also has fewer side effects like breast pain.

Good luck and please let us know how you get on!