Mirena being suggested for thickened (?) endometrium pre-menopause

[roundandroundthehouses]

I was wondering if anyone had experience of this. I'm 47 with no real perimenopausal symptoms yet, although my cycle has got shorter over the past 5 years or so.

Went to the GP with minor postcoital bleeding and was referred. Gynae found and cauterised a Nabothian cyst which he said could have caused the issue. He also did a transvaginal ultrasound 'to rule out anything more serious'.

Scan found my endometrial thickness to be 12mm (day 26 of my cycle so just before period). He said that anything over 10mm was too thick as I'm over 45. Took a (very uncomfortable!) biopsy to rule out endometrial cancer, which I understand is possible but very uncommon before menopause. I'm waiting for the results. If it's benign, he says he will recommend the Mirena coil to sort out the thickened endometrium. I can have it fitted when I go back for the results (assuming benign).

I have a couple of concerns. Firstly, anything I can find online says that 12mm is on the thick side, but within normal range at the end of a cycle. I can't find anything that says 10mm is the maximum over 45. Obviously he's the gynae, but I thought progesterone started to drop in perimenopause, and surely that would mean you had a thicker lining just as a natural effect of that? I always thought that was the cause of the heavy periods people sometimes get during perimenopause.

My other concern is that Mirena gets a bad press, particularly with its effect on mood. We are having a very difficult time in our family just now, and I'd really rather not start taking something that might make me less capable of dealing with it - unless a 12mm thickness is genuinely a problem. Would greatly appreciate any advice/experience.

I really liked my mirena but it decided to fall out. I don't know yet why it decided to leave me. But it did reduce the bleeding up until that point. Moods fine, I didn't even know it was there!

I love my mirena!
Was a bit of a bitch while it was settling on but now I have no periods and no weight gain or mood swings.

You can always have it taken out if it doesn't agree with you but it can take up to 6 months to settle.

I could do without the weight gain as well , but potential mood swings are what's really concerning me. Also the fact that I'd rather not medicate something that hasn't caused any symptoms and is possibly normal anyway!

@MyBeloved - if you wouldn't mind explaining, what sort of bitch was it when it was settling?

I did gain weight but I am not sure I can attribute all that to mirena
There is a lot of annoying spotting while it settles

Thanks, Bum . My periods aren't that heavy tbh, and the spotting was only postcoital, hopefully sorted by cauterising the cyst. I have to decide whether it's worth the potential mood issues and weight gain, I suppose. That's assuming the biopsy comes up negative, of course! I'm sort of blithely assuming that it will, but it isn't completely ruled out.

I have a Mirena as the progesterone part of my HRT, apart from 4.5 months of daily spotting I have had no other side effects.

Not sure if I made it clear....the spotting was after the fitting and continued for 4.5 but was extremely light...no spotting since, no weight gain, in fact I have lost some!

I won't have another put in until I know why this one came out. It was horrific!

Yeah I had it for this reason. I don't know what my thickness was but my diagnosis was endometrial hyperplasia. In other words too flipping much of it. Not enough progesterone to hold it back to normal levels.

I had v v heavy periods so that was my symptom.

Anyway, with anything that grows too much, cells can become corrupted. With endometrial hyperplasia there is a 25% chance of it developing into endometrial cancer.

So I got the Mirena in under GA. First one didn't settle right. I had cramps and I knew it wasn't right. After 6 months my consultant switched it out for a new one (again under GA). My lining was perfect at that procedure, so clearly the Mirena had worked, it had just been pinching me.

2nd Mirena was undetectable and my periods virtually stopped. Bliss.

So in the end I was a convert. I had no mood swings or weight gain that I noticed. In fact, once the bleeding was stopped, my mood lifted considerably!

roundandround, I was in a fair amount of pain/discomfort for a few weeks - possibly even 3 or 4 - after having the mirena fitted. I had to go and get strong pain killers from the doctor in order to manage. I also bled - went to what I'd class as heavy spotting - for around 2.5 months. My books also went up a generous cup size and we're sore to begin with. Then after around 3 months everything settled down and now I have absolutely no problem at all. I suffered terribly with endometriosis pain and heavy bleeding. The mirena has sorted all of these problems out too.

Boobs, not books

I'd rather my books grew a bit than my boobs, Beloved . Many thanks for all advice - am still thinking but now have a bit more info.

I assume it was a gynaecologist who did biopsy? I have a 19 mm endometrial hyperplasia - not unexpected because I am on Tamoxifen but recently had hysteroscopy for possible endometrial cancer. A GP shouldn't be biopsying - there are clear referral guidelines for suspected cancers. A gynaecologist would have better idea of normalcy at various stages of cycle. Mine did mention coil but bleeding has not been a problem - my hyperplasia was picked up on MRI scan. I'm going to leave well alone as per consultant recommendations. I'd avoid weight gain if possible, endometrial cancer is the type of cancer most closely linked to obesity because of oestrogen in fat cells.

Crumbs - yes, it was a gynaecologist who took the biopsy. It was so close to the end of my cycle that I'd fully expected to have to cancel the appointment, so likely to be about as thick as it ever gets. It's interesting that you've been advised to leave it alone - that's what I'd prefer to do, but am alarmed now by the 25% risk of cancer mentioned above. I'm a bit overweight but not obese, and aiming to lose a bit.

I rather assumed I did have endometrial cancer because of the tamoxifen but gynaecologist was brilliant and made an educated guess based on hysteroscopy that all was OK. The biopsy results will hopefully confirm this. I'm post rather than pre menopause though so that might be the difference. I was OK to have a hysterectomy just to be rid of risk altogether but she was adamant that wasn't a good idea and even with tamoxifen and being fat the risk was still very, very low. Hope yours is ok too.

Thank you :) - Apart from being about 10lbs overweight I have no other risk factors and am also pre-menopause, so am quite hopeful.

You know what? I was misremembering - only one type has that high a risk. I just looked it up. It depends on the condition of cells found.

^Simple without atypia: One percent risk of uterine cancer.
Complex without atypia: Three percent risk of uterine cancer.
Simple with atypia: Eight percent risk of uterine cancer.
Complex with atypia: The most significant type of endometrial hyperplasia. Twenty-nine percent of cases progress to uterine cancer and 17 to 59 percent of cases have coexistent uterine cancer.^

Sorry for alarming you!

Ahh, Elspeth, thank you so much for clarifying. If he uses one of those terms when describing the biopsy results I now have much more info in advance :)

Crumbs, I'm not sure whether you're still waiting for your biopsy results, but best of luck if so :)

Just an update, in case anyone is in a similar position in the future. I had my follow-up appointment today. Different gynae, who I liked much better .

First of all, the biopsy came up clear. It was taken from an area of my endometrium that measured 12mm where it was mostly around 10mm. This gynae said that as I'm still having periods with no menopausal symptoms, this measurement was perfectly normal for the end of a month. She didn't mention the Mirena either - I'd already decided to refuse it for now, so that saved me the trouble.

The postcoital bleeding is probably from a cervical erosion which the previous gynae apparently noticed but didn't mention. As I'm HPV negative this isn't sinister. She said I could have it removed under GA if I wanted, but I've decided not to in the meantime. So all fine :)

Glad to hear it. Biopsy fine for me too - just side effect of Tamoxifen.

Very glad to hear it, Crumbs :)

Hi
I went through exactly this a year ago. I had the Mirena fitted and although I think it's settled now, it did take longer than I expected. I had it fitted in Jan last year, continued with ongoing bleeding until about the end of March. Then bleed-free until the end of July when it started again. It wasn't bleeding at all, more dark borownish blood, like a heavy discharge but constant. I did get really fed up with it to be honest, not painful, but just really irritating. I went back to my GP in October (who were fab throughout and told me I shouldn't have to out up with all of this) as it hadn't stopped, he sent me back to my consultant, who prescribed additional progesterone tablets.

At this point the bleeding stopped and had not returned, so actually I didn't start taking the tablets. She did say that we were running out of options if it didn't clear up, so I wasn't looking at potentially a hysterectomy, but hopefully it's now ok. I'm nearly 51, so peri-menopausal I assume, but no real symptoms.

I hope this helps and things settle for you.