Mirena & HRT - Perimenopause Constant Bleeding

[Pollyjean1973]

looking for some advice on the mirena please as getting nowhere with my GP. I started HRT 2 years ago and initially took 200mg of Utrogestan daily. I really struggled with intermittent bleeding and so after 12 months I had the mirena coil fitted.

It’s now been a year and the bleeding still hasn’t settled down. I have a period every month and then spotting about one week later that lasts for days.

I am so over it and have an appointment with my GP next week to discuss my options. Has anyone had a similar experience and can offer any advice? I now want the mirena removed but not sure what to try next!!

My practice don’t seem to be clued up on this stuff at all and everything is a constant battle so I would like to be prepared!!

I have attached below the guidance on unscheduled bleeding with HRT - clicky links at the bottom for more comprehensive info. Your doctor might refer you for a scan to see if there is any cause of the bleeding for example, polyps, or fibroids.
What dose of estrogen are you taking? Although the Mirena coil can be very effective in controlling bleeding, and assuming it’s been checked and in place, if no cause is found and if bleeding still persists options might be to add in a Utrogestan tablet or reduce the oestrogen dose

https://thebms.org.uk/publications/bms-joint-guidelines/management-of-unscheduled-bleeding-on-hormone-replacement-therapy-hrt/

I had the Mirena coil fitted due to heavy periods and I never stopped bleeding for 3 months straight. It was horrendous. I had to have it removed.
I was found to have a uterine polyp which settled things a little.
Different in that I wasn’t taking HRT so I can’t comment on that.

A friend with really bad bleeding problems - who also tried the Mirena coil - has just had an ablation procedure. She has high hopes this will be the answer.

were you still having periods when you started hrt? what dose of oestrogen were you on? 200mg daily of utrogestan is an unnusal dose, unless on high dose oestrogen (although that in itself wont have caused the bleeding) . Also, unless you were defintiely post menopausal you should have started with a sequential regime, where you only take utrogestan for so many days a month (usually 12) This normally results in a regular monthly bleed without intermittent bleeding. The trouble with using a continuous regime (ie daily progeterone) when you are not post menopausal is that you are much more likely to exereince bleeding, often irregular, which then flags as unscheduled bleeding.

Hi clutefluffyunicorn. I started on sequential and took 200mg of Utrogestan for 12 days of the month. Before starting HRT I was having regular periods. After starting my periods became erratic and I had constant spotting. I persevered for 12 months and the tried the mirena in the hope it would settle the bleeding. I’ve had a scan and all is ok health wise so not sure what to try next.

I’ve had 2 years of spotting now and had enough!!

ah, thats annoying then @Pollyjean1973 You could try a different type of progesterone either orally longside your current oestrogen or change to try a combined pacth used sequentially (eg evorel sequi) some people find different progeterones better at controlling bleeding.

The mirena seems to be hit and miss for people. I had it fitted 5 years ago due to heavy bleeding and I have not bled at all since, it was life changing for me. Last year I started getting peri symptoms so I now have estrogen transdermal patch as well, both together seem to be working really well. I have to get my mirena replaced next week and I am beginning to get anxious that new one won't work as well. No reason to think that will happen but I am worried all the same

I had the mirena fitted, bled every day for 18 months until I had it removed

Its so disappointing isnt in. I am going to make an appointment to have it removed - back to square one after 2 years!

Thank you - I am going to have it removed cant see any improvement given its been 1 year. So frustrating that I'm back to square one.