Is Mirena better than utrogestan?

[HRTadvicepls]

Hiya,
I'm post menopause (or thought I was!) - last period July 2020.
Was put on Kliovance end 2020 (daily) then symptoms worsened so changed to utrogestan 100mg/day and 2 pumps Oestrogel daily in September last year. Upped to 4 pumps a day by GP in December and vaginal oestrogen added (can't remember the name sorry) for a week initially then twice a week.

Since then I had a heavy period in January, another in May and also June. Wasn't expecting that! GP referred to gynae on 2week pathway. Having a hysteroscopy this week as thickened lining and 'probable polyp' found on scan. Consultant suggested likely nothing sinister but maybe I don't have enough progesterone? She's suggested Mirena instead.

I'm a bit confused though about how it works. Utrogestan makes me sleepy the morning after, surely having continuous progesterone will be worse?! I've got long lasting post covid fatigue already. But I really don't want to be bleeding at random times anymore, fell way past all that.

Any advice please?

I'm a big fan of the mirena, because the progestogen acts locally the dose is lower and I find the side effects lower- however, I know some people say they struggle with the mirena- everyone I know IRL loves it though.

Thanks @cathyandclare . I had one many years ago for contraception and genuinely can't remember if/how it affected me! Good to hear of some positives.

I have a Mirena. It doesn’t make me tired.
As pp said, it’s a lower dose and it’s working right where it needs to be.

I'm waiting for mine to be changed, so have been put on tablet progesterone in the interim.

I'm not feeling great on it to be honest, and much prefer getting my progesterone from a Mirena!

If you don’t want a coil ask for a different progesterone tablet. The one you have is a ‘natural’type of progesterone that has the sleep side effect. You could try other tablets with a different chemical structure that doesn’t have the sleep side effects. Mirena has a chemical version that lasts for about five years.

Thanks all. @ButterCrackers it's not that I don't want a coil, just asking for advice/opinions. Could definitely do with waking up and not feeling hungover/more tired than when I went to bed so pleased to read it doesn't make you tired @DustyLee123 !
Hope you get yours changed soon @WellThisIsFun1 !

I can't comment on the mirena, but has your GP suggested taking the Utrogestan capsules vaginally?

I take Utrogestan cyclically and was on 200mg orally every 14 days out of 28. I was like a zombie! I switched to 100mg vaginally on the same schedule and no sleepiness. Additionally, despite halving the dosage, my breakthrough bleeds are much lighter as vaginal application is far more effective.

Just checking your timelines- were you post menopause (12 months and no period) when you went onto Kliovance?

Continuous combined HRT is for women with no period for a year at least.
If it's started too early, it doesn't control natural periods and that's why they keep coming.

Utrogestan makes me sleepy the morning after, surely having continuous progesterone will be worse?!

But if you are using 100mg dose, presumably that's every day now?

Having the Mirena will be the same- progestogen all the time.

The other thing is that on 4 pumps of gel, there has been some recent advice that this may require 200mgs Utrogestan a day, not 100mgs.

@Mammillaria The update on doses from the BMS is that vaginal dose has to be the same as oral for Utrogestan. 200mgs.
My consultant has never advised me to drop the dose with vaginal use (been using HRT for 15 years and Utrogestan for around 9.)

@JinglingSpringbells I just did what the doctor told me 🤷🏼‍♀️ They told me they weren't certain the July 2020 was a period (v light, lasted less than 48 hours) so considered me post menopause. Prior to that was May 2019 (normal period) and that was it since a 6 week bleed towards the end of 2018.

Yep to 100mg every night at the moment, orally. Consultant told me they swear by Mirena so I think I'm going to give it a go.

I am in very similar position and was advised to have coil. I haven't yet as dealing with arthritis flare up and don't want any more discomfort - I would struggle with being in position needed as arthritis is in hip. Ironically arthritis is why I went on HRT.

There is another thread today on similar subject with lots of people sharing their experiences of coil.

I don't seem to have any problems with the tablets but am having what is like a light period every 3 weeks. Have also had hospital scan and removal of benign polyp.

Doc now think I need to let everything settle ( I briefly increased my oestrogen gel ) or try coil. I am between two minds.

I hope you’re feeling fine soon 🍀

That's interesting, I'm due a review soon so I wonder whether they'll tell me to increase the dose. I'm with Newson Health.