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[Gingernoggin]

Hi all,

Just looking for some advice. I'm nearly 51 and my main symptoms are irregular prolonged periods (for the last three years), fatigue, feeling flat and zero sex drive! I've had various blood tests and scans and have one small fibroid and one small ovarian cyst (3cm) and my testosterone is very slightly elevated but otherwise I'd say I'm in good health - non smoker, healthy weight, eat fairly well, do yoga, walk dog, light drinker.

My question is do I try HRT or the mini pill first to get on top of the bleeding? My GP has offered me Elleste Duo 1mg but I'm not sure I need MORE estrogen. Won't that make the bleeding worse? My periods aren't regular, I skip two or three then I get a two week one. They're not that heavy but they do go forever! I also get a lot of spotting so I'm constantly on edge expecting random bleeds. I'm fed up of it and it's affecting my relationship. My partner is lovely and understanding but we've only been together two years and life is too damn short to feel rotten imho.

I'm even wondering if I should ask to go on the combined pill for six months just to get a break from the bleeding? I was on Marvelon a couple of times in my twenties without any problems. I know I'm older now but I don't see myself as a candidate for imminent stroke or blood clot.

I'm pretty sure my symptoms are normal for my age but I need a break! Any ideas?? I've tried most herbal things and I already take good supplements, e.g. multivitamin, magnesium, probiotic, fish oil, iron.

I think it's time to bring out the big guns 

[Venetia]

I can't advise on HRT but have been taking Cerazette (mini pill) for 18 months for heavy irregular bleeding (this was one of the options suggested by a gynae after scan/biopsy to rule out anything untoward which found one small fibroid).  I've had two heavy bleeds during that time but have otherwise had no bleeding or spotting, and the relief from the anxiety you describe regarding the uncertainty of when you might bleed again has been invaluable.  As I understand it doctors won't generally prescribed the combined pill to anyone over 50 but my doctor told me she would be willing to continue prescribing Cerazette till the age of 55 (I'm 54) when women are generally reckoned to have ended the reproductive phase of their lives.

[Dancinggirl]

Hi and welcome to MM
AS you are peri meno, then a sequential HRT might get your cycle sorted and you could get a predicable bleed each month.  However, if prolonged bleeding is an issue and you have fibroids and/or cysts then having a Mirena fitted would be a better option (this is good at shrinking fibroids and reducing bleeding) and then you could simply add some oestrogen as gel or patch to reduce hot flushes and night sweats. The Mirena with separate oestrogen is a very popular HRT combo that many gynaes recommended if bleeding, fibroids etc, are an issue.
There are new types of BCP that could be a good option to try and these are Qlaira and Zoely but at your age the Mirena could be better.
Here is some info that might help you:
https://www.menopausematters.co.uk/magazine/pdf/Article%20-%20Perils%20of%20the%20Perimenopause.pdf

TREATMENT options:   https://www.menopausematters.co.uk/perimeno.php

DG x

[Gingernoggin]

Thanks for replies Venetia and DG. Yeah I've been considering the mini pill, I did ask my GP about that but she seems keener for me to try HRT first.

She also suggested the Mirena coil and I have friends who like it and friends who couldn't get on with it. Tbh I'm really squeamish about the whole idea. I have a cervix that my GP described as "round the corner and up the stairs"  Smear tests are usually a bit of a faff for me so I'm worried about the fitting. I haven't had children and my understanding is that it's better for women who have given birth? I also hate the idea of something inside me that I can't see or stop using if it doesn't agree with me. I think my preference is to try tablets first and see how that goes.

I'm a bit scared about HRT, my gran died of breast cancer but then my mum and my aunt (her daughters) both went on estrogen after their hysterectomies and they loved it! In fact my aunt is 78 and still on it. She looks fab - about 15 years younger. I think 25/30 years ago, women just got everything whipped out at the first sign of trouble on the advice of their doctors - no internet to research alternatives!

I'm also a bit worried about side effects like weight gain. However, I also know that I could worry about this till the cows come home or get hit by a bus tomorrow  At some point, I think I just need to try SOMETHING.

[sadielouise78]

Hi Gingernoggin,

I am on HRT and the mini-pill (cerelle).  I had been on cerelle for a few years and my periods had just about stopped.  I'd go for sometimes 6 months without anything then I'd have a bleed.  Combined with other symptoms associated with peri-menopause the doctors decided to put me on HRT (Elleste Duo) but also advised me to stop taking the pill (long story but the specialist I saw thought I was post-meno so thought I didn't need the mini-pill anymore!).  Stopping the mini-pill was a disaster as I bled really heavily without it and whilst on HRT for over two months.  After a couple of month of the doctors scratching their heads I asked to go back on the mini-pill and have also moved onto another HRT (Femeston 2/10) and everything is now good again.  The bleeding has stopped (I've gone a whole month) and I feel so much better in myself.  I also have a couple of small fibroids and also have or have had an ovarian cyst.

I have tried the mirena coil and, like you, don't have any children and had a bad time at the doctors having it fitted so had it done at the hospital where it went in easily.  I found I bled terribly and had a lot of awful pain resulting in me having it taken out after 9 months.

You don't say if you have any other symptoms of menopause such as night sweats, hot flushes etc?

My advice, for what it's worth, would be to try the mini-pill before giving HRT a go.  If all you are wanting to control at the moment is prolonged periods then the pill may help you there.  I don't think the doctors will prescribe you the combined pill as you are over 40 but they will the mini-pill.

Hope it helps a little.

Sarah x

[Cassie]

When I saw the gynae recently he said that he has many many patients well into their 80s still on HRT

[Gingernoggin]

Thanks Sarah and Cassie. That's the thing - I don't get hot flushes and I sleep pretty well. Maybe the horrors of lashing sweat and insomnia are still to come! I remember getting night sweats about four years ago in my mid forties when my periods were more regular but they stopped just as suddenly as they came on.

It's all very confusing! I think my symptoms are related to excess estrogen (bleeding, swollen boobs, tiredness, low libido) but then I guess it's all relative, i.e. my estrogen levels are normal but high IN COMPARISON with my progesterone levels which are probably on the floor by my decrepit age. I read somewhere that estrogen stops bone formation which is why men are taller because they have less estrogen and women who are shorter and curvier have more estrogen. I'm tall and thin so I wonder if I just got used to operating on a lower level of estrogen my whole life which is is why I haven't had hot flushes yet? Oh who knows? Hurts my head trying to work this all out.

[Gingernoggin]

Forgot to say that I don't need contraception. OH has had the snip so it's really just whatever controls the bleeding that would be best I think. I don't know that I need estrogen yet. It's so hard to tell what is just ordinary tiredness from hormonal stuff. I do feel that I don't have as much energy as I used to. I'm a pretty busy person, full time job, voluntary placement, studying, long distance relationship so it's difficult to separate out what is the worst trigger.

[dahliagirl]

I went on hrt at 51, and was having many close together periods.  It seems to have worked ok for that, for me 

I would have given mirena a go, but I was too squeamish at the time and had recently come off the pill - would have had it years before if I had thought it was a good idea.  I sort of wish I had tried it though - I hummed and haaaed and then the GP who fitted them retired so I would have had to go to the FPC.  At the time, I thought my periods would probably not come back and I would have bypassed menopause and could dance merrily off into the sunset........ 

I did have a brief try of cerazette - I wasn't getting periods at the time that I tried it, but I did have an awful lot of frequent random spotting with it - in total, more than with my periods on the combined pill so I wasn't happy with it and it gave me terrible constipation problems.  So I ditched it and eventually my periods came back and got more frequent, I got big up and down swings, and that is when I tried the hrt.

[Gingernoggin]

Thanks Dahlia! Yeah I kinda wish I wasn't such a wimp about the Mirena. It would be amazing if it worked and so simple to then add estrogen gel or patches in time if necessary. That said, my experience of internal exams, smears etc has been painful and stressful and I just don't want it until I'm desperate. The idea of having a plastic thing inside me is weird although I appreciate it's no weirder than a pacemaker or something like that - not that I have a pacemaker!

Oh how naive I was to think I might be through all this by now! At least I'm glad that women are starting to talk about menopause more now. I can't believe I used to think that my periods would just get lighter and stop  More fool me! Uch I have much to be thankful for. Just need to keep a sense of humour, eat well, move my sorry ass more and talk to the doctor about options. When I'm 70 I'll think nearly 51 was really youthful no doubt 

[kinola67]

Hello, I have been on the mini pill for a number of years now and it was a life saver as I had bad ovarian cyst pain, nobody could work out what to do about it until I saw a locum gp who suggested the mini pill. There was erratic bleeding to start with but over the years really no bleeding which has been fantastic. I decided not to go with the mirena as the consultant I saw at the time really put me off by hassling me to do it and saying he needed to put it in when I had a period and the whole thing sounded hideous. I have younger friends who love it though. I started meno symptoms last year so have recently tried coming off the pill to see where I'm at, I felt great - no symptom at all! - for about a month, but I think I need to go back on it again now as I have my cyst pain again. As you say it's so totally confusing as whilst I expect to be dealing with the hot flushes, joint pain etc I now have to accept the cysts are forming again so have to deal with that at the same time. It all seems to be trial and error eg if I go back on the pill and get rid of the cyst pain, the meno symptoms might or might not come back which then means do I get HRT along with taking the mini pill? etc etc etc!!! It all depends what our hormone levels are and how fluctuating they are I guess. If you want to stop the bleeding you could try the mini pill which would give you a fairly good indication quite soon whether it will work for you. You do need to stick with it for a wee while though so it can settle down. Good luck!

[Gingernoggin]

Thank you Kinola67 that's really helpful. We must be the same age, I'm also a 1967 baby! Yep I think I'll ask to try the mini pill first and see how I get on. I've found one called Norgeston which is levonegestrel (sp?) which is the same type of progesten as the Mirena coil so that might give me an idea of how I'd be on the coil before I commit to anything drastic. That's my half baked theory anyway. Will see what the doc says. I've been bleeding again for a week after only one week of no bleeding. Before that, I had a two week period. I'm not flooding and it's manageable but it's tiring and inconvenient and flippin expensive! I'm going on holiday in June and I just want to not bleed for a while!

My feeling is I don't yet need estrogen. I think that might make the bleeding worse and I don't have flushes or sweats yet. Stupid menopause 

[kinola67]

Sorry not to have replied earlier! I kind of lost the way a bit with looking at the internet and got caught up with work and trying to get some sleep! I hope you managed to start the mini pill OK and that so far you've been fine. I have managed to get my cyst pain under control but having been back on the pill for a few weeks I'm starting to get my night sweats and insomnia back - joy! So it may be that I am now needing more estrogen but I still think I am prone to estrogen dominance, since seeing how quickly I went back to having all those symptoms after stopping the pill. so I saw the GP today to ask if there was anything she could recommend but she only came up with the mirena option again. I guess that would make sense 'if' I could tolerate it. Just too nervous to do that though, I don't really want to venture down this new route at this stage. Probably have tried that a few years ago!  stupidly I thought she could just prescribe a progesterone cream I could just use when and where I needed it - she looked horrified! of course as that doesn't exist on the NHS apparently. Let us know how it's going with you! yes 67 baby too!