Progesterone or coil

[WagonWheel1234]

I'm 50 and had perimenopausal symptoms for around 5 years, including some very bad problems with anxiety and sleep. I've been taking HRT for 18 months ish - oestragel every day and 2 x progesterone pills at night on days 15-26. It's been helpful for pm symptoms, but has some side effects including a horrendous period every 3 months or so and pain in lower back that comes and goes with my cycle. Cycle is now very irregular which doesn't help.

I was wondering whether it would be better to either switch to taking 1 x progesterone on days 1-25 of my cycle (which is apparently an option if I clear it with my GP), or switch to Mirena coil rather than taking progesterone. I love the days when I take progesterone as it really helps me sleep! But I can't help thinking that I'm on a bit of a hormone rollercoaster, and it might be better to do something less cyclical.

Previous GP wanted to put me on Mirena for contraception around 10 years ago, but I was put off by lots of negative posts on here! Have since heard more positive things about it, and it would be nice to give up on condoms (haven't actually gone through menopause, so can't be sure of not getting pregnant). But I'm concerned about a) having it put in and b) it not agreeing with me and having a fight to get that sorted. (My GP currently has 2-week wait at least for appointments. )

What are everyone's experiences/recommendations?

I wish I’d had the coil years ago, after I finished having babies.

Nothing is a one-way street. You can try both and see what you feel happier with.
I was offered the Mirena years ago (this is privately) and didn't fancy it for various reasons, but if I'd tried it, I could have had it removed after a reasonable time (like 3 months.)

You're going to get both sides of the experience here, and no one is you!

Can I just ask about the bleeding you are having now?
If you use Utrogestan as instructed for 12 days a month (starting on the same day of the month) you should get a fairly predictable bleed 3-4 days after the last tablet.

You say your periods are irregular. Are you trying to take Utrogestan when you think it's Day 15 of your natural cycles?

This doesn't work because cycle length changes. Gel + Utrogestan has to follow the same pattern as patches and tablets where the HRT sets the cycle, not women trying to work around their natural cycles.

Does this make sense?

Thanks for your reply - no I'm sticking to a strict 28 day cycle dictated by the HRT. Sometimes bleed at the end but sometimes at other times. Occasionally get a mid-cycle bleed. Periods roughly every 21-28 days but can be anything from 2 to 6 weeks and fairly unpredictable

I've got a Mirena coil and I'm so glad I got it. The fitting hurt but it didn't last long and the benefits have outweighed the discomfort of the fitting. But I understand your fears. I was also really worried that I wouldn't get on with it and wouldn't be able to get it removed.

I am 54 and just had my coil replaced, I also use Ostrogel and am happy with this combination.

I hated Utrogestan? It did the same to me, horrendously painful periods and really bad back pain that I required a prescription of Naproxen for it, it also caused PMT type symptoms and made me feel suicidal, and lots of breakthrough bleeding.

The best regime I’ve had is Tridestra HRT, it’s in tablet form and you take the estrogen for 3 months followed by medroxyprogesterone for two weeks, I loved it. The only problem was I’m lactose intolerant and these little buggers contain it ☹️. I’m now on an approved regime by a specialist where I have an estrogen patch and after 2 months I take medroxyprogesterone, this causes a bleed. I don’t have to have a bleed as at 51 I hadn’t had a period for a year, but I’m very, very intolerant to progesterone and this is the only way I can do it.

I refuse to have a Mirena coil, they’re so flippant as if I’m a freak for not wanting to try it. I tell them I’m so progesterone intolerant why would you think this is better for me. My sister in laws oncologist told her that because she’d had this coil for years it could be partly to blame for her breast cancer as it was a hormone dependent cancer, I’d never heard this before and they wouldn’t tell her this if it wasn’t true.

stand your ground and don’t have it if you don’t want to. Ask them for Tridestra, honestly it was brilliant.

Thanks @Snippit that's all useful

@Snippit Do you mind if I mention a couple of things in your post to @WagonWheel1234
I agree that a 3-month regime is worth thinking about. (I am on a longer cycle.)

However, there are risks with all progestogens and the stats at the moment show that MPA has the highest risk for breast cancer. This is when it's compared to Norethisterone (which comes 2nd), Dydrogesterone 3rd, and Utrogestan the least risky. (As far as they know.) Dydorgesterone (in Femoston) and Utrogestan are supposedly very similar.

The risks of the Mirena coil do exist as some does get into the system. It seems to have a similar risk to low doses of MPA and Norethisterone.

Obviously, the difference in risk between all of these types is relatively small and how often they are taken is also a factor. Sequential use appears safer than daily continuous combined.

Mirena works for me - insertion was painful briefly and then I had a day of cramps which was unpleasant. But since a month after insertion I've been period free, contraception is covered and I only need to remember to take/order my estrogen. I would ideally like to be taking a body-identical progesterone like utrogestan but I think the lower dose mitigates the use of the synthetic form.