Conflicting advice ... can anyone help?

[Troublesometuesday]

Hi all,
I have been reading these helpful threads over the past year or so, but still find the whole HRT thing tricky to get my head around!
Im 52, have been taking Elleste Duo for the past 18 months and have got on great with it. I also have the Mirena coil that is now past its effective date.
Had an appointment yesterday and my GP wants to put me on Elleste Duo Conti and remove the coil. So, I went to the sexual health unit in the same practice to make an appointment to get it removed, and had a quick chat with the Dr, who was a bit surprised and said it should stay in place for contraceptive reasons. I thought I was out of the danger zone on that front!
My GP’s alternative was to stay on my current medication and get a new Mirena coil inserted.
So, is it always so mind-boggling when trying,as an educated woman, to make the correct choice?

If you have had the Mirena coil AND HRT containing progestogen (not just estrogen) you have actually been doubling up on the progestogen (for your HRT) . While the coil was working ( 4 years) you only needed estrogen for HRT so your GP should have known that.

We need some form of progestogen with estrogen to stop the womb lining getting too thick which can lead eventually to cancerous changes.

You need contraception for up to a year after your last period (if you are over 50.) Have your periods stopped or do you not know?

Your GP is wrong. If you want a new Mirena it will a) act as a contraceptive and b) provide progestogen as part of the HRT.

So all you need with that is estrogen as a patch, gel or tablet.

If you decide not to have a Mirena, you would need to use something - condoms maybe for a year or two longer- to be sure of no pregnancy.

Thanks. I had the coil fitted in 2012, so I think the gp was right with the Elleste duo as the coil wouldn’t have been releasing progestegen.

But because I have have been on the Mirena, I haven’t had periods for years, so how would I know if they would have stopped naturally?

Surely leaving the coil in place will act as my contraceptive now - without faffing around with condoms?

It would have made more sense to have had the coil replaced 18 months ago and then used just estrogen for HRT because it's the progestogen in combined HRT that often causes side effects. If you have no side effects with a Mirena and intend to carry on with HRT for a few years it still might be better to have a new one. HRT which is Mirena = estrogen is considered the gold standard by many drs.

This explains about the Mirena, HRT and birth control.

www.menopausedoctor.co.uk/menopause/contraception-menopause-perimenopause

Thank you Queen, that was very helpful

The Mirena coil continues to give out some progestogen for several years - it doesn't just stop after 4 or 5 years and so if you were taking Elleste Duet as Queen of the Nights says you were getting too much progestogen - but the Mirena at this point would not be giving out sufficient for protection of the womb lining.

As you had the Mirena which stopped your periods - you won't know when they would have stopped naturally or indeed whether you have now reached menopause.There seems to be mixed advice as to whether the Mirena continues to provided sufficient contraception after the 5 years it is licensed for. Despite your age making conception unlikely, I wouldn't want to risk it so I agree with Queen of the Nights - get a new coil, add in some oestrogen and away you go - sorted! No condoms needed.

Thanks , but I still don’t know know why I can’t just keep in my Mirena coil which by now should just be useful for contraception only and stick with Elleste duo to provide the oestrogen and progestogen?
Is there something obvious I’m missing?

well you could but you may find you have side effects from having so much progestogen in your system from both the Mirena and a conti HRT.
They are also two different types.

From a safety aspect, it's synthetic progestogens that appear to be the trigger /connection with breast cancer, in some women and the stats show a rise after around 5 years with some types.

It's therefore worth thinking about whether using two sorts is a good idea though the amount in the Mirena will be very small now.

Queen - thanks for your reply. But if I keep the Mirena inserted in 2012 in place, surely I won’t be getting double the progestogen? So Elleste duet would be ok?
See what I mean about being confused!

I'm only going by what @Bellacio said when she said that even after 6 years there would be some hormones left in the Mirena- this is what you need to find out for certain one way or another.

Does the link i Ieft explain? if not a quick google should.