How much Utrogestan would I be allowed with an out-of-date Mirena?

[InhibitionOfExhibition]

I'm 45, have an 8 year old Mirena coil, and have started a trial of hrt due to bad anxiety and sleep issues.

Started with one pump of oestrogel and now added one nightly 100mg Utrogestan tablet.

I THINK the Utrogestan is actually doing something positive, which is exciting. But I see most of the trials where it's helped with sleep use at least 200mg rather than 100mg. I can't speak to menopause nurse for another 3 weeks, so can't ask this directly yet, but will they allow me to try going up to 200mg nightly? I don't have a cycle, so that 2 week on, 2 week off, pattern won't work for me. Does anyone do 200mg every night?!

TIA

Hi - there's quite a lot to unpick here to give you all the info you need.

First, your Mirena is out of date for HRT use. The licence is for 4 years as part of HRT although sometimes they allow 5 years. It will possibly be out of date for contraception so is that relevant? (I think they now say 8 years may be still effective but it's a grey area.)

So it either needs to come out or be replaced.

The 100mgs dose is for women who are post menopause and not had a natural period for 12 months. OR who are age 54+ when their periods are likely to have stopped or be very irregular. https://www.menopausematters.co.uk/postmeno.php
Very last paragraph on this page.

You might well have a cycle once your Mirena is removed as you're only 45. Unless you had a premature menopause, your dr should assume you still ovulate and will have a cycle.

This is because if you combined continuous is likely to result in erratic bleeding if used too soon- it's too low a dose to control the growth of the womb lining (because you will still be ovulating and producing your own estrogen.)

There are no trials showing effects of sedation (not in a positive way) not sure where you've seen that? The dose is based on the control of the uterine lining, not the side effects of sedation (which some women find unacceptable.)
It doesn't always work that way either- I've used it for 11 years and sleep less well on it.

Sorry not to give you the direct answer you want. But from what you've said you should be using a sequential type of HRT which is 12 days x 200mgs a month OR have the Mirena replaced. You shouldn't use both as it's too much progesterone and different types.

Thank you for your reply.

The paper linked below analyses data from different studies and finds progesterone overall helps sleep. But most studies are postmenopausal women and also higher doses than 100mg:

https://academic.oup.com/jcem/article/106/4/e942/6007680

GP was fine with Mirena being in for contraception for another few months. I would guess perhaps it's no longer releasing much progesterone, but in any case apparently it's OK to have both.

Thanks again.

The trial was very small and only half the results showed better sleep and the final part (the conclusion) of it says that by introducing estrogen, the outcome was different. So this wasn't a trial looking at using it for HRT.

Yes, but the point is everyone is different and sleep is not the main driver behind the dose of Utrogestan.

It's an odd trial to use anyway because Utrogestan is prescribed to women who have a uterus and it needs protecting from the estrogen.
It's not prescribed in itself for sleep.

There's no harm in using 200mgs but just be aware that there are side effects that can include constipation, a higher body temp, a hung over feeling etc.

You will find this forum FULL of complaints from women using 200mgs and who swap to something else.

It's very individual.