Menopause, mirena coil, vagifem & tingly bits!

[over50andfab]

Looking for advice here - I'm 57, hadn't gone through menopause up to the back end of last year when I got the mirena coil fitted to help with menorrhagia (dual purpose not to get pregnant )

Everything was great - no problem with getting it put in, no periods since (even threw away my mooncup ). However, after daring to have sex - a lot of sex (yay!), I got diagnosed with vaginal atrophy (boo!) and was given Vagifem, which worked well. than I stopped having sex (even boo-er), felt I didn't need the Vagifem any more and stopped taking it after 2-3 months.

TMI warning! - first I started with a tingly clitoris (thought it was missing the sex and it has gradually morphed into bladder problems - frequent need to wee and tingling (not burning as in cystitis) in between, feeling of not emptying bladder properly. Then there is the feeling of "bearing down" on my uterus (a bit like the opposite of pelvic floor). Also tingling in my left foot and up my leg.

So....I googled! It seems Mirena can cause these problems regardless of age. Or could it be that mirena is progesterone and I need to start the vagifem (estradiol) again to balance it out? Or if I had the mirena taken out (and potentially invest in another mooncup unless I've miraculously stopped periods in the last 10 months!) might this sort it?

Oh - apparently my uterus is tilted to the left (left leg tingling...) - I had a smear last week and asked.

Any suggested gratefully received on which way to go with this. a tingly clit is definitely NOT the way to go on a permanent basis

Btw it is not sti related - have checked that!

[PollyPerky]

Were you having regular periods last year right up to 56 /57? That's highly unusual. You will be in the 1-2% of women still having periods at that age. The odds are you are now post menopause but won't know as you have the Mirena in place.

Vagifem or Ovestin ( a cream instead of a pessary) is for life. No good stopping after 2-3 months or the symptoms will come back. Bit like putting moisturiser on your face or hands- if you stop, your skin gets dry again.

If your GP told you to stop ( as some do) they are wrong. NICE guidelines say use long term. (I've used Ovestin for 10 years but am also on systemic HRT.)

The amount of estrogen in Vagifem or Ovestin doesn't get into your system - the effect is purely localised - or having or not having a Mirena won't matter.

To get rid of the tingling you might find it helps to use Ovestin cream externally as well as Vagifem as a pessary because the estrogen in Vagifem won't get to your vulva.

[over50andfab]

Thanks PollyPerky I think I saw something you wrote on this a couple of years ago and wondered about the bladder connection - or not.

Periods had been changing a bit last year - in that longer one month, then missing the next every 5 months or so (I kept a record).

Tbh I haven't been using the Vagifem for a few months now and there's been no dryness since I stopped Possibly the dryness I had was just due to all the sex after previously having none for a long time. The GP said to use it as and when needed (actually a consultant said that too!)

I just don't really like taking anything, so if the mirena is causing the problems I'd prefer to get it removed. However if it isn't will Vagifem - or Ovestin help with the tingling and bladder problems?

[PollyPerky]

Tbh I haven't been using the Vagifem for a few months now and there's been no dryness since I stopped Possibly the dryness I had was just due to all the sex after previously having none for a long time. The GP said to use it as and when needed (actually a consultant said that too!)

Vaginal estrogen has 2 functions- to keep the vagina plump and healthy :) (if it gets really dry it can bleed just from the walls rubbing together- forget sex!) and the estrogen is also absorbed by the bladder and urethra to help build up the lining. The lining has estrogen receptors. This is why low estrogen often equals tetchy bladders, loads of weeing, pain or tingling etc.

The Mirena isn't causing the problem. Lack of estrogen is.

You don't have to 'feel ' dry to be dry! Dryness means loss of lubrication (but may not be noticeable ) but also the vagina shrinks. If this goes too far, it's a devil of a job to reverse it- some women have to use dilators to stretch it all again.

Your consultant wasnt right to say use as required - it's not lube which is used on a 'when it's needed basis'. It takes several weeks for the changes to occur from an atrophied vagina to one that has thick walls again - the estrogen actually changes the structure of the walls again.

My advice is that you keep using it. It's a tiny tiny amount. Old ladies in the 90s use it.

I don't think I've ever written 'vagina' as much in a post . :)

[over50andfab]

Thanks PollyPerky I get what you're saying. I am wondering why leaflets for Vagifem (and Ovestin having googled it) say only to use as long as is needed? There is, actually potentially some "low level" interaction with something else I take orally so might be a case of changing one or the other.

Damn - should have asked the nurse doing the smear test if my vagina still looked plump and healthy

I'l start it again I think, if only to see if it helps with the tingling/bladder, and go see the GP when I get the smear results!

[PollyPerky]

I don't know what you mean by 'some low level interaction with something else you might take orally'. What's the 'something else'?
1:4 women use systemic HRT AND vaginal estrogen. There is no interaction because the estrogen in Vagifem and Ovestin stays in the vagina only. There may be the tiniest bit of systemic absorption during the first 2 weeks, but once the tissues have recovered, the cells have a tougher cell wall and don't allow the estrogen to be absorbed into the body (I have read a very long research report on this if you wonder how I know!)

This is from the Nice Menopause guidelines- google and you can find the report.

This is the information that drs are supposed to give to women.

Urogenital atrophy

1.4.9 Offer vaginal oestrogen to women with urogenital atrophy (including those on systemic HRT) and continue treatment for as long as needed to relieve symptoms.

1.4.10 Consider vaginal oestrogen for women with urogenital atrophy in whom systemic HRT is contraindicated, after seeking advice from a healthcare professional with expertise in menopause.

1.4.11 If vaginal oestrogen does not relieve symptoms of urogenital atrophy, consider increasing the dose after seeking advice from a healthcare professional with expertise in menopause.

1.4.12 Explain to women with urogenital atrophy that:

symptoms often come back when treatment is stopped

adverse effects from vaginal oestrogen are very rare

they should report unscheduled vaginal bleeding to their GP.

1.4.13 Advise women with vaginal dryness that moisturisers and lubricants can be used alone or in addition to vaginal oestrogen.

1.4.14 Do not offer routine monitoring of endometrial thickness during treatment for urogenital atrophy.

[over50andfab]

Thank you for all that. Interesting to know how much menopause can affect the bladder as well as the vagina. I have been reading about this for the last 2 hours now!!! And started on the vagifem again...

Sorry to be obscure - the "something else" in my case is akin to, say, St Johns Wort, which actually has a moderate interaction. It is something I will check.

Love that MN always has someone that can answer pretty well anything

[PollyPerky]

There are no drugs you take orally that will interact with vaginal estrogen. I've explained how it is not absorbed systemically.

[over50andfab]

Hate to argue but there are quite a few that need extra monitoring for potential interaction if taken together with vagifem - eg warfarin is one. Just google vagifem interaction.

[PollyPerky]

I'm not sure which sites you are looking at but unless this is coming from the RCOG I'd be wary of reading something online.

[PollyPerky]

One thing you need to be aware of is that any warnings and risks which are linked to HRT tend to be listed any ANY HRT whether it's vaginal estrogen or systemic HRT. I've seen hundreds of posts on forums from women who are worried about the 'risks' of vaginal estrogen as listed on the leaflet that comes with it. This is a manufacturing 'quirk'- the warnings and risks are NOT for vaginal products. They use the same leaflet /info for any HRT.

If you are worried, ask a pharmacist.

[PollyPerky]

I'm sorry but I think you are confusing systemic HRT with vaginal / topical HRT.
There is some info online about the use of warfarin with HRT but it's not vaginal HRT! If someone was on warfarin they would have a clotting disorder and it's most likely they'd be under the care of a consultant if they wanted to use HRT.

You don't seem to accept that there is no absorption with vaginal estrogen- it's the equivalent to something like 1 HRT pill per year.

[over50andfab]

Pretty well everything you say is true - and yes, there is an incredibly small amount of drug in Vagifem that is localised in the vagina. However, and this is where it gets more technical, it is metabolised in the liver by the the CYP3A4 enzyme. If you are on anything else that is metabolised there, this is where there could be interaction. The Estradiol could in effect become more potent, which is where long term monitoring comes into play.

This is, of course, why there is always the standard info in any leaflet that says you need to discuss everything you are taking with your GP.

[PollyPerky]

over50 I'm not sure where your original question is going! Are you saying you are wary of using it?

You asked for advice on treatment for your VA symptoms but this has become a thread on the interaction with other drugs - which is not an issue and you'll struggle to find any GP who knows anything about this (it's really something only a specialist would know) .

Vagifem and Ovestin are NOT metabolised by the liver. It is a 'first bypass' treatment. Even systemic transdermal HRT is not metabolised by the liver, which is why they do not increase blood clots. Anything you have read online about Warfarin and HRT would only apply to oral pills (HRT).

This is from this paper www.ncbi.nlm.nih.gov/pmc/articles/PMC3252029/

Because vaginal estrogens fall into the general category of estrogen therapies, package inserts on local vaginal estrogen treatments carry the same warnings as systemic estrogens.

There is some evidence that in women who have severe atrophy, there may be some minute systemic absorption in the first 2 weeks' use until the cells lining the vagina thicken. However, even in women who have had breast cancer, vaginal estrogen can be used in many instances.

You might find this useful to read. www.ncbi.nlm.nih.gov/pmc/articles/PMC3252029/

[over50andfab]

Sorry, warfarin was a really bad example! Not so much wary - just have to be careful on anything I take. And you are right, my GP would not know that much.

As for my original question...although all your advice is great (and illuminating) and will hopefully sort the bladder problems, I actually posted to find other womens' experiences with the Mirena coil in that could it be the cause of the tingling down my left leg and in the general area??

[PollyPerky]

just have to be careful on anything I take.
Do you accept that vaginal estrogen is not 'taking' anything? :) (It doesn't get into your blood stream.)

You are getting far more chemicals- synthetic progestogens- in your system with the Mirena than you would with anything for VA.

Never heard of tingling leg with the Mirena. Sounds as if it's something else.