HRT advice

[3catsandcounting]

I'm 53 and have had the Mirena coil in-situ for 7 years (no bleeding at all in this time). At my last smear, the doc told me I could leave it in there for a few years yet.

In the past 12-18 months I've had peri symptoms, which are getting worse.
Tiredness, irritability, anxiety, low mood, loss of libido, dry hair, skin, vagina(!).

Last year my GP prescribed me HRT (Premique) which, after some googling, appeared to be the 'old style' medication and didn't seem that popular. I decided not to start the treatment, and see how things went.

I'm now at at stage where I need some intervention, so I've made an appt with the GP to discuss HRT again.
Thing is, it's the same GP as I saw previously, and I'm not sure she's that clued up. I don't know enough about the various treatments, so anyone got any recommendations, bearing in mind my age, and having an old Mirena, and no bleeding?
I realise everyone is different, but just looking for advice.

The life of the Mirena is for 4 years . There is some good basic info on this site www.swbh.nhs.uk/wp-content/uploads/2012/06/Hormone-replacement-therapy-ML36061.pdf

So the Mirena won't be having any effect at all now- not sure why you were advised it could be left in? It might give a type of contraceptive effect like the ordinary copper coil but it won't stop any bleeding.

Maybe your periods have stopped now and you are post menopause? The Mirena would have stopped working 3 years ago so no bleeding at all now presumably means your periods have stopped.

It's clear your dr doesn't know much about HRT because Premique is a) old style using conjugated oestrogen and b) a combined type of HRT which means it contains both oestrogen and progestogen. Combined HRT is for women who are post menopause and not having periods.

If the Mirena still had some progestogen in it- which it won't now- then you didn't need additional progestogen with a combined type of HRT- you'd only need oestrogen alone.

The advice now is to use transdermal HRT (patches or gel ) as they are safer re. blood clots. The other advice is not to use artificial oestrogen like Premique and Premarin. You could use an oestrogen patch or gel, plus a separate progesterone such as Utrogestan (micronised natural progesterone.) You could take the progesterone daily which means you'd have no withdrawal bleed or for a few days a month which would give you a bleed each month. it's personal preference- most of the unwanted side effects with HRT are from the progesterone not oestrogen so some of us like to minimise how many days we use it. You could also have a new Mirena and use oestrogen as gel or a patch. That way you'd have no bleed either.

Sorry if this sounds a lot to take in. Suggest you look at www.menopausematters.co.uk for lots of advice and also the forum.

Polly - thank you so much; some great advice.
I know my Mirena is old (and I am still using it for contraception) but I do get mild period-type pains on a semi regular basis, together with pmt symptoms. If I was post-menopause with no coil hormones left, this wouldn't be happening, would it?
So, not definitely knowing if I'm peri or post, what can the dr prescribe on that basis?

Just read the link you sent on HRT, which has made things clearer for me.
I just want to be armed with as much info as I can get for my appt.

It's quite possible to have 'phantom' periods- all the signs of a period but no bleeding. This can happen during peri or even when periods have stopped.
TBH the only way you will find out is to remove the coil, but it certainly won't be stopping bleeding without hormones in it now- in fact ordinary copper coils are notorious for making bleeds heavier. You could /should try sequential HRT for 6 months then try combined if you want to later on. They say combined is fine for women over 54 and the odds of conceiving at 53 are almost non existent.

Ok thanks. Two of my work colleagues (same age as me) have recently started HRT and are evangelical about it!
I know we all react differently to various treatments, but I'm feeling quite positive and open to at least trying something that might just make life a bit easier.

If you've been happy with a Mirena- easily fitted, no side effects- then your best bet is a new one and then oestrogen added as a patch or gel.
Best to have a good think on what you want and ask your dr for it, if she's not up to speed. Many drs dish out pills and aren't aware of all the other ways of giving HRT. Thankfully the British Menopause Society is doing on going training for GPs but it's going to take some time to reach all of them.

Bumping to find out how you got on 3Cats as I came on to post an identical thread.

I'm also 53 with a 7 year old Mirena. I'm seeing the doctor next week to discuss what next. No idea whether I've been through the menopause, I do have some symptoms and also have osteoporosis so was thinking of asking about HRT.

What treatment are you having at the moment for your osteoporosis? Was HRT never mentioned to you as a possible option?

I had surgery for a parathyroid adenoma last year - this was the cause of the osteoporosis so my Endocrinologist is hoping that I will recover, will be having another DEXA scan later this year. He suggested I ask the GP about HRT though.

Best - thanks for the bump, my appt is in 2 weeks so I'm still googling to gather info. Think there's any chance my GP might have attended this upcoming conference by then, Polly?

Excellent advice BTW Polly. Thank you.

Come back and update 3cats. Let me know how you get on.

Just wanted to say that Polly- your advice is bang on the money. I've POF and was fortunate to access the right treatment at the right time from one of the leading menopause specialists in the uk - which has lead me to be on gel + utrogestan but since moving out of London I've had such a hard time trying to convince other GPs and gynaed as to why I'm on the meds I'm on. So- thank you for being so clued up!

Best are you on bisphosphonates or any kind of drugs for your osteo?
sage hope you continue to get what you need.

Polly, I was on a calcium and vit D supplement but they asked me to stop taking it, they also prescribed me alendronic acid before I had the surgery but I didn't want to take it. It is just over borderline and they think it should rectify itself now my calcium levels are normal. We will see at the next scan.

Borderline being 'just' into osteoporosis?
TBH the evidence is that calcium & Vit D alone do nothing. There are quite a few research papers online about this where they compare low dose HRT against calcium and Vit D, and taken on its own the calcium & Vit D don't do anything to increase bone density.

Have a look at this
www.ncbi.nlm.nih.gov/pubmed/18063490

Sorry- meant to add- are you going to see a rheumatologist about your bones? If you have a T--score that is now below -2.5 , it's not likely that if you are post meno you will improve that without some kind of intervention; bone loss post meno can be up to 3-5% each year for a few years. Don't let things get any worse!

Thanks Polly, I was -2.6 in my forearms I think. My spine was ok though. Should I ask for a referral to a rheumatologist? My list of questions for the doc is growing...

If you had the usual DEXA scan then they don't measure forearms; they measure your hip / pelvis and lumbar spine. These are the areas most likely to fracture. Can I be nosy and ask how old you are and if you are post meno? You can PM me if you want.

Yes, your right, they usually only do the hip/spine. They did the forearm because I had primary Hyperparathyroidism, a condition where one of the parathyroid glands goes rogue and results in calcium being drawn from the bones and sent via the bloodstream to the organs and joints etc. My hip measurement was similar to my wrist.

You're not your sorry.

Update! Well, I went to the GP this morning, who has prescribed Femoston-conti (lower dose) and has also taken bloods to check for underactive thyroid (tiredness, my voice is quite hoarse and eyebrows are thinning - I sound like a catch!)
So, we'll see how it goes.

Ive only just found this, but wanted to say that I have a Mirena coil (which is almost 4 years old, so due out in the next month or so) and the oestrogen patches. Been on the patches for 4 months, and not only do I feel like a new woman, but I'm getting compliments about 'how well' I'm looking from others, too.

My GP - who I saw yesterday - said that 'in theory' the Mirena coil could work for another year or so, but 4 years was the optimum. The thought of the pitter patter of another set of feet fills me with dread!

Are you keeping your Mirena 3cats? I'm keeping mine for a few more years and been prescribed Ovestin.

Do you mean Ovestin or do you mean Oestrogel? (Ovestin is a cream for vaginal atrophy)