Utrogestan to Mirana

[Wheretheskyisblue]

I am in need of some contraception and my gp has suggested the mirena coil. However I am wondering whether all the data on the benefits of hrt is as strong with mirena which I understand is not body identical like utrogestan.

I am mainly on hrt for oesteoporosis, is it just the oestrogen that is important with this, or does the progesterone also impact? Will non body identical progestrone be as effective?

I am also worried about headaches with mirana as I used to get these with the mini pill but have been clear of these on hrt. Are these likely with mirana?

If anyone has any experiece of the mirena coil it would be really appreciated.

I've had good experience with the Mirena coil. I use estrogen patches too. I think it's the estrogen part of HRT that's the important bit for bone protection.

Thank you. Did you find the mirena gave you headaches or changed your mood?

I'm also on HRT mainly for maintaining bone strength, and I use Oestrogel + the Mirena system. I was worried about getting the Mirena because in the past I have reacted badly to the progesterone component of the Pill (headache and low mood), but I have been fine with the Mirena, and I've had it for 18 months now. The first week or so, I did get a hint of the old 'hormone headache', but it stopped. Now I'm not aware of it at all - and no low mood either.

That is really reassuring, many thanks. I assume as it is much lower dose than the pill it generally has less side effects.

I have however found a few articles on the value of natural progesterone in treating osteoporosis so I am wondering what to do. I wonder if I can carry on taking utrogestran as well as mirana.
www.lifeextension.com/magazine/1999/3/treating-osteoporosis

Estrogen regulates the activity of osteoclasts, which results in the slowing of the process of older bone dissolution. Progesterone, on the other hand, promotes the production of osteoblasts which are required to effect new bone formation. Natural progesterone has been shown to stimulate osteoblast-mediated new bone formation which is required to prevent and reverse osteoporosis.

I believe it’s the oestrogeen that helps with the osteoporosis. The progesterone is just to balance out the oestrogen, if you take that alone it’s a risk for uterine cancer.

If you had problems with the mini pill I would be concerned you have some kind of intolerance to synthetic progesterone and will be similarly affected by the mirena. Trouble with that is you'll need to get someone to remove it. What about an old school coil?

I had been doing some reading as I'd actually found more Utrogestan continuously to be better for my aches and pains and joints. And had seen bits here and there about additional bone density benefits.

I don't see why you can't continue taking some as well; mirena is supposed to be locally acting, though some women do experience side effects. Most love it.

There's another smaller prog coil with less prog that I read somewhere may have been recently licensed for hrt or is given as last resort. You could request that for contraception and remain on utrogestan continuously?

I'm now on 100 patches and edging to 125 I think (review next week). A friend who is a Gp had recent meno training and suggested I should be on x2 the utro dose for higher patch levels, as in 100. My own Gp felt it was if you're going above 100 patches, but agreed to allow it. Im definitely feeling so much better joint wise. (Im breaking for 3 days each month at my request, though it's Gp wasn't bothered if I didn't.)

That's interesting WarrierNun. My fear is that my GP may not be that enlightened and allow me to continue to take utrogestan when I am on Mirana.

I am wondering if there is any guidance on doses of progesterone I can take according to oestrogen doses that I can present her with? I am currently on the 75 patches but could increase to 100 to up the progesterone. I am also not sure how much progesterone mirana provides compared to utrogestan.

Mirena changed my mood for the better.

I was considering taking the mini pill to help even out ups and downs along side Utrogestan which would have been allowed so I don't see why not.

They would say no based on the fact that the mirena is very effective for the prog side of hrt, even with higher doses. So simply wouldn't see the point of both.

They may query the impact of extra progesterone. Oestrogen alone does not increase breast cancer risk; it's very slightly increased with synthetic progesterones. They haven't properly researched Utrogestan but they think there's either no or much less risk. (And the increased risk is v small) So you may have to work with a Gp who's willing to weigh up the position, or a consultant.

The oestrogen is known to be the key bone density hormone though so you are in the right thing there.

I suppose it's if they'd consider a different coil for the contraceptive part and keep you on the Utrogestan for the hrt side. You could certainly ask.

The menopause matters forum is a really good long running forum and you may find more answers there. I believe you can also email Dr Curry who is a BMS member and runs the forum for advice for a low fee. (Iirc around £30/40)

I can't comment on the headaches, but should be part of the discussion with your Gp.

This may be helpful

thebms.org.uk/wp-content/uploads/2021/10/14-BMS-TfC-Progestogens-and-endometrial-protection-01H.pdf

From that doc under unscheduled bleeding:

"Those on continuous combined HRT regimens that contain a progestogen in a combined preparation or have the levonorgestrel intrauterine system, could have micronised progesterone/ medroxyprogesterone acetate or norethisterone added to their HRT regimen. If breakthrough bleeding occurs following the switch to continuous combined HRT and does not settle after three to six months, then the woman can be switched back to a sequential regimen for at least another year."

The progesterone is there to thin the uterine lining and this is their primary concern. Here they say you can have Utrogestan with the coil for this situation.

The reason they like the mirena is that it's localised to the area that needs it. It's one of those things that many women have to try to see if it suits them.