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[marmite]

Hi
I'm new to this forum and was wondering if anyone has any advice:

I had two children at 38 years and 42 years - Before I had my last child, I had a blood test to check my fertility and was told I was perimenapausal, however I managed to conceive and gave birth to a large bouncing baby!

Afterwards I developed a cystocele prolapse - I have managed this over the years with pelvic exercises and a pessary silicone cube which I put in and remove myself - I found before a period my prolapse and bladder control would get worse but the nurse said this was the weight of the blood in my womb pushing down on everything.

My periods stopped around Dec 2013 and my prolapse improved slightly but in Oct 2015 nearly two years later I had a major heavy period. I was given a scan and all was ok (my mind is a little rusty but I think this was the time I saw a follow up consultant who said I still had follicles on my ovaries)

However by the Dec my flushes and night sweats came back and I just couldn't take it any longer and asked my GP for HRT.

She was unsure what to put me on and said it was a bit of trial and error but as I had no period for two years apart from the one heavy one she put me on Evoril Conti 50 - This was fine for some time but I had a couple of incidents with lightish breakthrough bleeding and had a few scans but all was ok

In May 2017 I had an on off breakthough bleed that stop / started over three weeks.
My GP referred me for a scan and all was ok but they decided to follow it through with a hysteroscopy - The consultant nurse at the time said I had obviously had my own oestrogen surge which had contributed to this and perhaps I should be on a sequential patch

Due to holidays / cancellations etc. I had my hysteroscopy in Oct just gone. However in the August prior, I started getting terrible night sweats and flushes again. I mentioned this at my hysteroscopy appointment and they decided to refer me to the Menopause Clinic.

During my hysteroscopy procedure, they said all was ok, I did have blood vessels in my womb which could indicate that I still had activity (period wise) but this could be the HRT.

Whilst waiting for the Menopause Clinic appointment, I just couldn't cope with the flushes and night sweats so having spoken to others who have done this, I doubled my patches - After a couple of weeks this definitely improved things and I felt normal again.

I saw the Consultant at the Menopause clinic early December. I got the feeling he hadn't really read my notes and just said to stop the bleeding and protect my womb, the best solution was the Mirena coil.
I was a bit apprehensive about this with my prolapse, I really didn't want anything evasive - I asked for literature but he just said I didn't use literature for doubling up on my patches and they were invasive. I pretty much felt pushed into the option of the coil as he suggested no alternative and he just said if I didn't have it I'd have to keep having 'invasive' hysteroscopies.

He also said that although the hysteroscopy all looked ok the biopsy sample hadnt worked and I would have to have a repeated hysteroscopy.
When I agreed to the coil (under duress) he said during the next hysteroscopy, if my womb looked thin and ok, they wouldnt bother with the biospy but implant it then!

I came away rather upset and decided to see my GP - She had concerns like myself not about the coil and my prolapse but my pessary cube as it is placed high up and has a lot of suction to stay in place. (my head was in such a turmoil at Meno Clnic I did not ask consultant about the cube and coil, I asked about prolaspe and he said it was ok)

She said if I hadn't had a bleed since May 2017, then I really didn't need the coil, it was for women who bleed all the time.
I told her I was doubling up on patches and she said, she would investigate the best HRT solution for me and let me know but she did not have a problem with me doubling up for now.

She tried to ring me and I have tried to ring her but we kept missing each other and I thought all was going ok and not urgent. However around mid December I started to have worse bladder control and prolapse problems like I use to get before a period. On the 16th December I decided to half my extra patch and just use one and a half as I though perhaps using 2 patches was causing these problems.

That same day I had a breakthrough bleeding and period like pains which lasted a few days. With the kids off school, family visiting and Christmas commitments, I decided I'd sort it out later in New Year.

However on 30th December I then started to bleed again, this time much more heavily like a real period with fresh blood and stomach and back ache again.
At first I thought it might be reducing my patches to one and a half. I am still bleeding and last night I had terrible night sweats so perhaps the one and a half patches is not working but don't want to go back to two patches as perhaps this is what has caused the bleeding.

I am trying to contact my GP but cant get through but I don't know how to move forward and whats the best solution - I can't cope without HRT as I get terrible flushes and sweats (my mum is 72 and she still gets hot flushes so we seem to be inflicted badly)

Obviously I am worried sick about this bleeding but having had a hysteroscopy that all looked fine two months ago, I keep trying to reassure myself.
My GP has previously said she doesn't think I should go on sequential patches but I wonder if the extra oestrgen is just triggering my body into bleeding and perhaps I would be better on it? The nurse at my last scan said I am just one of those people whose body just doesnt follow the rules ie. a period after two years!

Any advice would be greatly appreciated.

[Hurdity]

Hi marmite

 

Gosh that sounds a long and complicated story with a not very satisfactory outcome!

First re Mirena - there is no problem having this even if you don't bleed all the time. It is used as a contraceptive as well as providing the progestogen part of HRT so if you want one of these you should ask for it - but not sure if it is suitable as you say re your prolapse and the pessary cube? The only thing about the Mirena is that if you are late peri-menopausal (or post-meno) you would not want to have it without additional oestrogen as it could thin the lining too much- but you are not wanting this option anyway.

However if you don't want to have this (Mirena) and there is nothing amiss re your womb, then to prevent breakthrough bleeding it would be best to have sequential HRT and then at least most of the time your bleed should happen at the same time each month and towards the end or just after the progestogen part. If you are not yet post-menopausal as you seem to have been told then this is a better solution anyway rather than have continuous combined HRT before you are post-meno.

If you need quite high oestrogen to deal with your symptoms then it is best to take separate oestrogen and progestogen so that you can adjust the dose of each independently. Oestrogen patches go up to 100 mcg and with these you would either have the Mirena, or Provera tablets or utrogestan (progesterone) for approx 12 days per month which would give you the regular bleed.

Hope this helps

Hurdity x

[Dancinggirl]

I had the Mirena for 4 years in post meno - found it the best option at that time.  It's not just for women who need contraception or have problematic bleeding, so it's a good option as part of HRT and is less likely to cause the type of bleeding you are experiencing.  You can also use as little or as much oestrogen as you need with the Mirena in place. Oestrogen patches or gel would possibly give you better absorption.
Do check with the consultant about the tube - I doubt this would be a problem as the Mirena is actually inserted inside the neck of the uterus.  A bit of spotting is quite common with any non bleed HRT and as you have had recent scans I really wouldn't worry.  I expect your lining has built up a bit with the increased dosage and is breaking away. 

Hurdity, as always, has given you some good advice. 

I would personally seriously consider having the Mirena if you want to use high doses of oestrogen without and bleed.  DG x

[marmite]

Thank you Hurdity and Dancinggirl for your support and advice.
I thought I'd deleted this post and replaced it in the 'All Things Menopause' thread - but I do find nowadays I am a lot more scatty than I use to be!

My concern with the Mirena coil is that the strings that you check in your vagina could interfere with my cube. When I insert my cube, I have to push it up as high as possible - Having a prolapse, I can often feel my cervix and am pushing this up with my cube! Some nurses have suggested that previous bleeds could be due to my cube slightly opening up the cervix.
The cube also works by suction and to release it I have to insert my fingers to break the seal so there's quite a bit of suction. It'd be interesting to know if anyone else has ever had the coil fitted with the cube...

However I like the cube, it manages and puts me in control of my condition and is a lot better than having to have invasive surgery and vaginal mesh, which I now hear they are planning on banning!

I am happy to have a bleed if I know its a scheduled one and not something to worry about - My current bleed is a lot more than spotting and is more like a regular period, I think as you've suggested it may be due to the increase in oestrogen by using two 50mcg patches and then as another contributor said (in the other thread) reducing the extra patch to a half thus withdrawing some progesterone.

I wanted to see if this would alleviate some of the new symptoms I was having and whether I could cope on 75mcg rather than two patches that equate to 100mcg as I'm sure the less the better. However I feel as if my old symptoms are returning.

I'm lucky to have a very understanding GP who actually told me about this website when I started on HRT, the problem is she's part-time so trying to make an appointment is difficult! - I shall probably wait till I can see her at the special Women's Clinic on Monday unless the bleeding gets any heavier.

Marmite x

[Taz2]

Is your cube for uterine prolapse marmite as your cervix sounds as if it is quite low?

Taz x

[marmite]

Hi Taz
Its for general vaginal prolapse, cystocele, they said my uterus has descended too. Sometimes it's much higher, I have good and bad days probably depending on hormones and how much on feet I've been / lifting I've done!

Thanks
Marmite x