Stay on combined pill or move to HRT plus coil?

[PoorPhaedra]

Re-posting here from women’s health as advised!

I saw my GP today to discuss a series of symptoms I’ve been having for quite a while that sound very much like perimenopause. I’m 45 with two kids. I’m currently on the combined pill and have been since I was 17.
She said that HRT is not compatible with the combined pill and if I start on oestrogen gel I will need to either move to the mini-pill or have a Mirena coil.

Years of reading mumsnet have given me an absolute fear of the coil - I don’t want my depression, mood swings, weight gain etc to get worse!

Also my combined pill already contains oestrogen and progesterone (which is what the coil and gel would give me) so I’m wondering if changing my pill and starting HRT will actually make a difference to my hormones or whether it just risks a whole host of side effects making my life worse?
Maybe I should stick with the combined pill and try antidepressants?

Has anyone been in this position and what did you do? The GP was lovely but I couldn’t come to a decision in my 10 minute consultation. She was pushing the mirena coil option but I’m so wary of making my symptoms even worse

Hopefully @JinglingSpringBells will see your post and advise

Yes, she's right in so much as you can't use the Pill and HRT.

You can use the mini pill in larger doses alongside HRT- estrogen only- as the progesterone in the mini pill gives the progesterone side of HRT.

Your GP may not know this so you may have to find a specialist- either a private GP trained in menopause or a gynaecologist trained in menopause/HRT (you can self-refer to both. Many also offer video consultations.)

To be honest, you could give the Mirena coil a whirl for 3 months and see how that goes. Again, you could have this done privately and have it removed after 3 months if it's not for you.

There is a bias on forums where women tend to post negative experiences (the coil) but some find it wonderful. You won't know till you try it.

Or you could reconsider your type of contraception and go for condoms and 'full HRT'.

Antidepressants are no longer recommended for peri meno hormone mood swings and anxiety- HRT is the treatment.

https://thebms.org.uk/wp-content/uploads/2024/02/15-BMS-TfC-HRT-preparations-and-equivalent-alternatives-JAN2024-B.pdf

I found you this @PoorPhaedra

on Page 6 it explains how 3 Noriday per day (mini pill) can be used as HRT (with estrogen as gel or a patch.)
It's off-licence so your GP would need to agree.

Thank you so much. My GP did mention moving to the mini pill and then also taking progesterone tabs two weeks per month on top of the gel but it seemed a lot to have to remember!

I’ve tried to look online to find out the amount of oestrogen and progesterone in the combined pill as compared to mini pill/mirena and gel as I figured if it was the same amount, I wouldn’t be gaining anything.

This is interesting and something I didn't know. I've been on hrt patches and fortnightly progesterone for 2 years. I also take the mini pill. GP knew I was taking pill this when prescribing hrt.

Can you explain what you mean when you say you can take the mini pill in larger doses? Also why is it a problem to have progesterone from the pill and from the hrt? Thanks

Your GP is correct that HRT isn’t compatible with the combined pill, but that doesn’t mean you’re out of options.

The combined pill contains synthetic oestrogen and progestogen, which already provides some hormonal support, but it’s not the same as body-identical HRT. If you’re experiencing perimenopausal symptoms, switching to HRT could be beneficial.

Here’s why they suggest either the mini-pill or the Mirena coil:

✔️ HRT needs a separate progestogen to protect your womb lining if you're taking estrogen gel. The combined pill contains a higher dose of synthetic estrogen, which isn’t designed for menopause support.
✔️ The mini-pill (progestogen-only pill) or Mirena coil provides the needed progesterone to protect your womb while you take body-identical estrogen gel, patches, or spray. The Mirena coil has the added benefit of reducing heavy bleeding.

You could ask your GP about your options for switching and whether HRT is right for you now. Would you feel comfortable exploring a gradual transition from the pill to HRT?

A gradual transition means your not without your added hormones your body has been used to so psychologically and physically less daunting.

Since the combined pill masks natural hormone fluctuations, it can be tricky to tell how far into perimenopause you are. You might notice symptoms. A transition would mean opting for progesterone only pill since combined pill it’s not compatible with HRT. It’s worth considering.
Then at some point introducing body identical oestrogen.

If you have the coil fitted at a NHS sexual health/women’s health clinic they are extremely experienced in placement of the coil.

As I’m sure you already know with HRT there isn’t a one size fits all so it’s always worth exploring all your options when considering what is best for you!

Sometimes like most things it’s trial and error. But I would say definitely don’t dismiss the coil based on other horror stories! If it bleeds it leads. Meaning we rarely hear the good news stories Becuase they don’t sell but bad stories everyone tells everyone about them.

Good luck x

I love my coil, wish I’d had it as soon as my periods got heavier.

You could take Noriday x 3 for 12 days a month- that's the progesterone part of HRT and you'd need that anyway as some sort of progesterone. And for the rest of the month you'd just take 1 as contraception.

@Misstabithabean The link is at 8.34am - report from the British Menopause Society- Page.
Noriday is listed as an off-licence progestogen for HRT. 3 tablets daily.

I don't know if it's problem having both. But if you can simply increase the amount of mini pill so it's also HRT I wonder why you aren't being offered that instead of also using Utrogestan?

@Menoglow I am assuming the info you left in your 2nd post at 10.24- the long one- is from a website.

Could you link to the medical website so posters know the source.

@JinglingSpringbells

As a nurse with extensive experience in women’s health both professionally and personally, I’ve spent years researching and staying up to date with the latest evidence-based guidance on menopause, HRT, and alternative therapies. My insights come from both clinical knowledge and firsthand experience, ensuring that I provide well-rounded, factual information rather than just pulling from generic websites.
The information I share is based on reputable sources such as NICE guidelines, NHS research, and peer-reviewed studies, as well as my own training and practice. I’m always happy to discuss the science behind it, as I believe informed choices are key to managing menopause effectively.

I was unsure by the use of bold and italics because they are normally used for direct quotes, copied and pasted from a medical source or a link. But when I clicked on those lines they weren't links.

I'm not asking this for myself, but I wasn't sure where the info source was by the way it was set out.

It comes from my own work and resources that I’ve created/collated so I can copy and paste as and when needed to help other women. 😊