Peri Late 30s - is Mirena Coil the way to go?

[TrustInFate]

Hi all,

I strongly suspect I'm in peri.

Fast approaching 40, symptoms include: my usually very regular monthly cycles are now every 2 weeks and very heavy; awful brain fog; much sweatier than previous; hair greasier; skin and eyes dryer; constant aching throughout my bones and muscles; anxiety; migraines aligning with my cycles; poor sleep.

I've heard that the usual starting point in peri menopause is just to get a Mirena Coil...which DH would love tbh as we've talked about it for ages and I've always bottled out of because I had one years ago and it was literally the most excruciating pain of my life having the thing inserted. Far worse than childbirth. Is this still the best starting point?

And does HRT come later down the line, when in full blown menopause?

I will try to speak to my GP but I don't have high hopes, they tend to be very dismissive about everything.

It's worth getting symptoms checked out in case it's something else but Mirena is a good option if you've got heavy periods regardless of whether it's peri or not. It's been a god send for me anyway (although I agree that having it fitted wasn't fun). I went straight onto estrogen patches at the same time as getting the Mirena but you could see how you get on with just the Mirena before deciding what to do next. Definitely have a chat to your GP.

Also, if you're not using it for HRT, there are some smaller versions of the hormonal coil (Kyleena?). Not suitable for HRT but might be an option if you just need it for contraception and heavy periods. Might be less painful to insert.

The mirena is just one part of HRT - the progesterone part. So if you’re wanting it for HRT you’ll need to get the oestrogen prescribed as well. Another option - which is the same thing in effect if you don’t want the coil but still need contraception- is to take the mini pill and then have oestrogen alongside that (the mini pill is progesterone only like the mirena, you’d still need some extra progesterone alongside it - unlike the mirena, although some prescribers disagree with this now it’s all a bit confusing and depends how much oestrogen you need). I take the mini pill, oestrogel for oestrogen and utrogestan 100mg every night. I’m 42 and have been in early menopause since 37 due to autoimmune issues.

Also - if you are having symptoms of menopause you can ask for HRT. Nice clinical guidelines state that blood tests are unreliable in diagnosing menopause so they should only be used to exclude other conditions in women under 45 that might cause similar symptoms. If these come back okay then you are perfectly reasonable to ask to start HRT.

You can take 2 x desogestrel as the progesterone part of HRT if you don't want Mirena but need contraception.

Confusingly some of the symptoms in early peri can be down to progesterone fluctuations (migraine is one) rather than oestrogen but it can be difficult to work out what's causing what. And yes, it's quite normal to be on HRT in peri, I was 48 and still having periods when I started HRT.

If you start needing to get up at night to pee get checked out for VA. This can be an early warning sign.

Thanks all. Don't know whether to push for HRT or try mirena first. I can take a pill as I'm on enzyme inducing medication for migraine which would make it absorb too quickly.

If you decide to get the mirena I would recommend going to a sexual health clinic. I had one fitted a few years back at the clinic and the staff were great. I explained that I was fearful of the pain due to an excruciating coil fit many years ago so they suggested a local anaesthetic gel and injection. I went ahead with this and it worked really well for me. It was a totally different experience to the first time!

The Mirena coil did not help my Peri symptoms at all. I only got relief when I went on birth control pills.

Thank you that's really helpful, the idea of a clinic just makes me think I'd be sat there with a load of teenagers!

Oh I hope that isn't the case for me as pills aren't an option with my other meds

Are you sure that you can't take birth control pills with the enzyme inducing medication. All I'm seeing is that it reduces the effectiveness of the hormones to prevent getting pregnant. I'm not seeing that it's contraindicated otherwise. You may well be able to take them for your peri symptoms, but will still need to use another means of birth control. Please check this with a doctor who knows what they are talking about.

@SofiaAmes it won't be contraindicated in the sense of doing me any harm, it's just unlikely to work properly. My medication means anything I take digestively passes through my system very quickly. I will ask the Dr though but that's always been the case with any other digestive medications in the 20 years I've been on it...I can't take antibiotics etc orally either. I think I'd need a patch or coil of some sort if I had HRT to bypass my digestive system instead

Oestrogel is rubbed into the skin and you can take utrogestan vaginally.

Can't speak for peri but for me, Mirena has been amazing. No periods, no PMS, total freedom. Seems like there are widely varying experiences though. I'd ask for it for contraception though, probably easier.

I've got a Mirena and I love it. My periods have gone completely (previously very heavy since peri started). It was a bit more uncomfortable than a smear test getting it put in, but well worth it. I also use the oestrogen gel for my HRT.