Can I break out the champagne yet?

[Peartree17]

I'm 52. I had a Mirena coil inserted after surgery to remove a dermoid cyst and the ovary and fallopian tube it was growing upon 2 years ago. At that point, I was still ovulating. Within a couple of months, my periods had stopped. Of course, I couldn't tell if this was due to the Mirena coil or the onset of menopause. I thought I might be having hot flushes and night sweats - certainly my sleep became pretty bad - but these symptoms were closely linked to lifestyle and environment e.g. hot flushes coincided with a July holiday in Japan, insomnia and night sweats invariably linked to alcohol consumption.

So...I had the results of my blood tests for FSH and LH back and talked to the GP today. Turns out my results are deep, deep, deep into menopause territory - FSH of 129. Since I've stopped drinking (and therefore cut out the anxiety that accompanies the insomnia) and increased my exercise, my sleep is good and I'm losing weight. Also feel calmer. I may or may not have brain fog, but since I no longer work full-time, I'm not living in such a mentally challenging environment, so I can't really tell if my performance is impaired!

So, my question is: is menopause now over? The GP said I should keep the coil for another 3 years (the progesteron might be helpful) but I didn't really probe with questions. Am I through it and can I consider it done and dusted?

Hmmm...there's a lot here to talk about!

why did you have a Mirena coil? Was it for contraception or for heavy periods (I can't see why the op necessitated a coil...but maybe am missing something.)

my understanding is that no blood tests for meno are accurate when using any type of hormone implant, meds etc. The Mirena can inhibit ovulation.

But, at 52 and with 1 ovary you are unlikely to have any more periods I imagine.

The thing is, end of periods is just for many of us the START of menopause and symptoms. I didn't have a single meno symptom till I was almost 53 when I started missing the odd period. Once I'd had a 4 month gap , the symptoms started.

The coil won't 'help' menopausal flushes etc anyway- in fact it might make them worse, on its own. Synthetic progestogen which is in the coil doesn't help flushes, sweats, dry vagina, bladder frequency, bone loss etc.

In an ideal world you need to:
have your coil removed and have blood tests again in 3-6 months.
continue with contraception until you see if you have more periods.
if you get menopausal symptoms you could have another coil PLUS estrogen as a type of HRT.

In short, it's too soon to say if you can drink the champagne yet. Meno symptoms can carry on for years and years after a final period. There seems to be this idea that once periods stop, that's it and end of. Nope!

Info here about the Mirena and FSH. Says it's ok to test with just the Mirena but not combined HRT.
Other info about fertility with Mirena etc.

www.gpnotebook.co.uk/simplepage.cfm?ID=x20130226163801685340

Thanks for reply Polly. I was using the coil as contraception prior to the op. It had to be removed during the op, and the surgeon replaced it (with my consent) with the Mirena coil. TBH, I don't know why, except that it reduces chance of womb cancer (by keeping the lining thin)? Anyway, I didn't and don't experience the problems that others report on the Mirena - weight gain, skin problems. I just stopped having periods. And therefore, missing a key marker for where I was in terms of menopause.

So I had blood tests about 16 months ago, which showed that my oestrogen levels were dropping, but not in whatever the menopause zone was (I haven't kept the results, so sorry to be a bit vague). In this most recent set of tests, the GP highlighted the FSH and LH results, both of which were very menopausal.

I don't want to remove my coil because, as has been said here before, the Mirena coil plus oestrogen is considered a very good HRT regime. So I'm sort of future-proofing myself in the event I do want HRT. I suspect most London GPs would rather hand out pills that insert a coil then add patches/drops - probably cheaper and quicker. And I"m not so fond of having coils removed and inserted that I want to do it more often than absolutely necessary.

None of the four different GPs that have been involved in ordering/reviewing my blood tests to date have said the Mirena renders these results unreliable, which seems odd. Why would they order blood tests and take up appointment time on them if they are unhelpful?

Anyway, I guess the good news, for me, is that provided I am sensible about drinking, diet and exercise, I seem to be able to avoid the insomnia, night sweats and hot flushes. And that in turn leads to feeling happier and calmer. The bad news is that I really don't seem to be able to cope with even delicious red wine any more, and that's a loss. As for vaginal dryness and lower libido: nothing that more foreplay and a little judicious lube can't fix!

Sorry, cross-post - I didn't see your second post with the link. If I have read it right, the GP(s) have followed guidelines in getting FSH readings for me because I am using progesteron-only, so there should be no interference; and the GP who said to retain it for a further 3 years, is following the guideline that says, keep it in until 55 when fertility is deemed at an end in 96% of women. (Roughly translated)

Obviously you have not got VA yet, so would have loved to sort that out with just lube!
I use a Mirena with Estrogel great combination if you want to consider systemic HRT st some point.

THank you NK3, for the tip - dunno what VA is, but you are hinting at something horrific! I think I"m going to make like the ostrich for the time being and assume that an easy menstrual history and easy pregnancies, plus general good health point to an easy menopause.

VA= vaginal atrophy.

Read about it. It's when your vagina dries out and can get shorter and tighter, can bleed as it's sore inside and you can find your bladder reacts too.

This can't be cured by lube. You'd need estrogen cream to sort it and use it long term (for life sometimes.)

The menopause has 2 stages - short term symptoms like flushes and sweats, moods etc ( although some women still get these in their 80s) and longer term symptoms like VA, bladder issues, joint issues, bone loss etc. These happen gradually anywhere from 3- 20 years after menopause. Many women who are unwell in their 60s and 70s don't make the connection between loss of estrogen and their symptoms.

There is no connection between easy periods, easy births, and good health- easy menopause.

My mum had all of those but still had flushes in her mid 80s, and VA and insomnia.

So did I- but went on HRT asap (before I was 80!)

I had easy births, no problem periods never needed painkillers for them, exercise regularly and passed all recent blood tests-with flying colours!
But have I paid for it in the undercarriage department with this meno lark!!

Full HRT for me, I plan to take it long term!

So if in the short term I manage to control insomnia/hot flushes without HRT, HRT is nevertheless still available for later life to deal with joint pain, bone loss, etc? My mum took HRT for a long time, not sure when she stopped - but she still has osteo-arthritis, osteoporosis. Is this just not called ageing?

Oestrogen cream sounds the biz for the old vag. But I think we might be relying a lot on oral and hand-jobs by the sounds of it...

HRT is best used within 10 years of menopause.

Osteoporosis and osteoarthritis are totally different. Arthritis is a degenerative condition through wear and tear. Osteoporosis is low bone density= fractures and possible death through hip fracture complications or disability due to spinal fractures.

Thanks for the continued conversation Polly. So what qualifies as menopause? I have not had a period since about January 2016 (post Mirena) and my FSH levels suggest that my oestrogen levels are consistent with menopause. Does that mean I should begin HRT within 10 years of now in order to get the benefits for better bone density, happier vagina, joints in better condition, etc? And I would then be continuing for how long? throughout the rest of my life? Do people do that? Sorry to sound so ignorant, but even the NICE guidelines don't really venture into 'HRT and impact on later life' and GPs are extremely busy. I can hardly ask for a referral to a meno clinic in order for a little chat about hypothetical scenarios. Also, I feel well, provided I look after myself and don't harass my system with alcohol, and because of the Mirena, I'm not being confronted with menstrual changes. So it does all feel very theoretical at the moment.

Does that mean I should begin HRT within 10 years of now in order to get the benefits for better bone density, happier vagina, joints in better condition, etc?

Yes, if you feel your symptoms warrant it. There is what they call a 'window of opportunity' for HRT when the benefits outweigh the risks. Starting HRT in your 60s is possible but the risks of blood clots are slightly higher.

If you just want a happy vagina (and who doesn't! :) ) then vaginal estrogen (not classed as HRT) is fine.

If your mum has osteoporosis you ought to discuss with your GP as it's hereditary and you should qualify for an NHS DEXA scan now on that basis. If they won't do this you can pay for it yourself (about £200 and repeat every 3 years.)

How long you use HRT is up to you. Unfortunately, many GPs are still in the dark ages with the old 5-year rule whereas most top consultants say it can be used for life, as along as you are aware of the small risks and are otherwise healthier.

I'm coming up to 10 years on it and have no plans to stop unless anything changes. PM me if you want .

Thanks Polly! I have a lot to learn. Good advice on the bone scan - hadn't a clue. Will follow up.