Post menopausal spotting with oestrogen cream

[667TheNeighbourOfTheBeast]

I’m very worried as I’m 56 and been on HRT for 6 years (Estrodot patches plus topical oestrogen cream and testosterone) and today had some very light spotting. This is so unusual for me I contacted my doctor and have an appointment next week. I’ve had a Mirena coil since 2004 and my last one was changed 2019. But I’ve recently changed from using oestrogen pessaries (been using these since age 49) to oestrogen cream internally, and I’m wondering if it could be this. I’ve not had any spotting at all for many years possibly nearly 15 due to the Mirena. I’m under a menopause consultant and my oestrogen levels were within the acceptable range last time I had a blood test in October. I can’t remember last time I had a smear test but I’ve never missed one and I think it’s within the last 4 years. The doctor said she would need to examine me to see if I needed to be referred, but I have read that it’s usual procedure to be referred if you’re over 50 and post menopause. I had previously had a benign ovarian cyst a few years ago but didn’t have spotting with it and it was monitored and disappeared . Has anyone had anything similar please ?

Can you double check the use of the Mirena with HRT? I thought it was licensed for 4 years as part off HRT (but it may be 5- I'd need to Google!)

If it's 4 years then that would explain the spotting- it's run out of hormone.

Are you seeing your consultant or a GP next?
Was there a special reason why you see a consultant (ie other issues before) or is it choice and a private appt?

Post meno bleeding is usually investigated but when HRT is being used along with a Mirena, they'd possibly consider hormonal imbalances first - because the Mirena is the first line of treatment for hyperplasia anyway (thickened lining) and it's unlikely you have anything more serious having used one for years. (They'll probably refer you for a scan .)

Hi thank you for replying. I think I was told Mirena would be good for 5 years but a quick google says 4 years so it’s now four and a half as I had it inserted in April 2019. Had no further spotting.
I was referred to an NHS meno clinic as I was struggling with side effects of HRT and also have an underlying condition (don’t want to disclose on here as it’s not a common one and don’t want to identify myself!)
I pushed for this as the GP didn’t seem to know what to do next. I’m feeling less worried now than I was so thank you very much for that info😊
Im seeing my GP this coming week and I also coincidentally have a telephone appointment with the menopause nurse from the clinic. I’m definitely going to ask for a local anaesthetic this time for Mirena as the last one was very painful I’m not sure why as had a few over the years but generally feel my pain tolerance gone down after menopause!

Just an update I saw my GP today and she did a vaginal examination plus took swabs for STDs despite me telling her this wasn’t likely but I guess they have to check. She said this would take a week to come back. Having looked at NHS guidelines for post menopausal bleeding I’m surprised that she didn’t refer me for a scan etc. She also dismissed the idea that it could be the Mirena running low on oestrogen, however she is a GP and not a menopause specialist. She said it may be worth just keeping an eye on it if it happens again but this doesn’t seem to be what others have said on here as it’s usually a red flag even if it happens once. I suspect it is probably the Mirena coming to the end of its life but I don’t feel confident about the doctor tbh. She seemed to be unconcerned but this is extremely unusual for me to have any spotting etc,

Go back and see someone else?
You should have a scan at least within 2 weeks.

Hi thank you for coming back to me so quickly. I find it very difficult to challenge doctors but this just doesn’t feel right. I also mentioned that I have lost weight unintentionally not a huge amount about half a stone over many weeks as I’ve had loss of appetite. I think this is due to my being on an increased dose of Lanzoprazole for acid reflux as it coincided with increasing the dosage, however this is another slightly niggling worry at the back of my mind. I’m speaking to the menopause nurse at the clinic this week either tomorrow or Thursday I can’t remember,I’m going to mention it to her as well and see what she thinks.

Just to update this thread, I spoke to menopause nurse and she didn’t seem unduly concerned. She said she thought it was most due to vaginal atrophy. She said she didn’t think it was the coil coming to end of it’s life(not sure how they can say this when it’s 4 years 6 months ) as she said 5 years for Mirena. I’m sceptical about this as guidelines say 4 to 5 years I suspect this is about saving money tbh. Will be insisting on a scan if there is any repeat of spotting.

I am on my third mirena coil and the 2 previous times I have found that they start to run low on hormones at around the 4 year mark, then symptoms like spotting and cramping start to come back, I'm now approaching the 4 year mark with my present coil so I will see what happens, I'm 53 and going through menopause.

TBH I don't think a nurse (with respect to nurses) is qualified or experienced enough to make that call.

There is little difference between Vagifem and Ovestin (they are slightly different types of estrogen but shouldn't make such a difference.)

I'd push for a scan. Remind them of the guidance on this.

It's 99% certainly nothing and likely to be the Mirena running low on progestin.
However, they have a duty of care to get you checked out and not just guess what's going on.

If you are on HRT post menopause, slight bleeding isn't urgent or surprising. If you bleed post menopause and don't take HRT it's a two week wait referral to gyne.

@JinglingSpringbells Thank you again for taking the time to reply. There were a couple of things that concerned me after speaking to the meno nurse. She asked me if I could have caught myself with my finger nail when I had described the blood as being brownish pink like the end of a period and not bright red “fresh” blood. She also suggested it could be due to VA and pushing while having a bowel movement! I could be wrong but this just sounds like nonsense to me. The GP has put me down on list to get could changed in April which will be exactly 5 years. A few years ago I was getting breast pain and some other symptoms, tbh I can’t remember what now, and the GP changed my coil before the 5 years to see if that would help and it did (it wasn’t spotting though) just wondering now if this is about money saving as it’s literally a few months away and not out of the question it could be the Mirena.
@susiedaisy1912 did they change your coil early when you had these symptoms ?

Yes they did. I had it changed later in the 4th year so not much earlier but it took me a while to realise that the symptoms were coming back, then by the time I managed to get an appointment to discuss it, I then had to book a coil fitting appointment separately it had taken a few months.

What are you going to do now?
Rather than worrying, you either need to push for a scan which means seeing your GP or another one, or contacting the consultant in the NHS.
Or pay to see a gynae privately.

What the nurse said can happen (scratches etc) BUT it's best to rule out the more serious issues and then accept it's whatever has happened for other more minor reasons.

It's not true that spotting on hrt is always 'nothing'. MOST of the time it is. But it needs checking and it's more likely your coil has given up the ghost.

Just wanted to post an update on this and apologies it’s been a really long time but I’m not on here very much. I had no further spotting and am due to get my coil changed next week.