Mirena six weeks in - heavy bleeding and fatigue - should I persevere?

[abdnhiker]

Hi, looking for advice and other women’s experiences with a Mirena coil as part of HRT. I’m not having a good time of it and wondering if there’s any point in persevering or if I should get it removed now.

I am six weeks into having a Mirena coil with my Everol 50 patches, previously I was on sequential utrogestan (2x100 for 14 days per 28). I was experiencing spotting in the week before my period so was referred to gynaecology and have had a hysteroscopy. (I’m still waiting on the biopsy results but I’ve been told she did not see anything concerning so am trying to not worry that way.) The gynaecologist recommended a Mirena coil to get rid of the spotting and it was inserted at the same time as the hysteroscopy.

Since getting the coil I have increasing levels of fatigue. I have had to take a few days off work, am struggling to manage family responsibilities with my teens, have drastically limited my social life (what I had of one), and am unable to exercise as I normally do although I’m trying to keep active. I feel like I’m not sleeping well; no matter how long I’m asleep I’m not well rested, and I’m having more hot and cold flashes than normal and am rather weepy. Basically, this summer has been shite and we’ve not had a holiday as I’m really not well enough to cope with being away.

I have also had extremely heavy bleeding, I normally have an easy period for 3-4 days but my first period in late July was 19 days with horrible cramps, clots, and flooding. I’m now on day 8 of my second period which is also very heavy compared to my normal. I’ve had a blood test and I’m not anaemic and a swab for infection that was negative.

I know that heavier and longer periods can happen during the first six months with a Mirena but this feels like an understatement in my case and the fatigue is getting worse instead of better.

Has anyone had this heavy bleeding and fatigue and did it resolve after time? Or am I better off giving up now and asking the GP to remove it? My GP is suggesting I try for four more weeks and if it’s not significantly better we could remove it then but that means ten weeks of this for no benefit.

Did anyone persevere through it and is it worth trying? Or am I miserable for no benefit? Obviously given I’ll keep spotting without it, and this means I might continually look like I have a chance of cancer but the GP says that maybe that’s what will need to happen.

My GP has also suggested I could take one utrogestan capsule a night too to see if that helps settle the bleeding and my mood. Has anyone tried this?

I have a six week check with the gynaecologist on Tuesday so wanted to get advice and opinions before I speak with her - really appreciate any advice or experience anyone has.

I have had it 20 odd years (replaced at points when expired) and recall bleeding solidly for the first 3 months, then spotting. Then, drumroll, NO PERIODS at all after this. Weirdly, whenever I had surgery, I would have a day or two with a breakthrough bleed, but apart from that, nothing. I would now definitely be in menopause at my age but have been er had any real symptoms, and I just get my Mirena replaced every 7 years. Initially it’s for contraceptive purposes, which has 8 years on it now and I understand it’s 5 for HRT purposes but I seem to have success so far rattling around until 7 years so I’ve made a choice to go with that.

My experience with the mirena coil was bad.

It was put in to combat heavy, flooding periods but it didn't. I truly gave it a chance but bled for a year with it before absolutely insisting it was removed. I'd have had it removed much sooner except that it was Covid and the lockdowns so appointments were in very short supply. I'd also met some resistance from doctors when I had asked about removal anyway. They can be very reluctant to remove it sometimes.

If it isn't working for you then get it removed. But be prepared to be very assertive and insistent.

My GP kept pushing the Mirena on me, but I'd tried Microgynon once and felt absolute shite on it so always resisted. They are both levonogestrel. Can you try desogestrel pills instead? I found I tolerated it much better. I had very light, regular periods on it for a few months and then none at all.

Thanks everyone - it just seems so unpredictable. I will try to get some guidance from the gynaecologist as to whether she thinks it’s likely to resolve and if so, how many weeks more to stick it out. @HoppingPavlova fingers crossed that this is my body adjusting the way yours did - that would be the best case outcome and I’d hate to give up too quickly.

I’m lucky in that my GP has said she’ll remove if I need - our sons went to nursery together 16 years ago and as embarrassing as it can be with a GP who knows you outside of the surgery, I feel like it helps that she knows me and knows that the hormones really are impacting my body in negative ways and that this isn’t my normal.

@Topseyt123 - not being able to get it removed due to lockdown must have been horrible - I would be struggling even more mentally if I didn’t know I could get it out if I decided to.

@spoonbillstretford is levonogestrel in the minipill? I was on that after my first child and no issues with it but that was almost twenty years ago now. I’ll ask the gynae but I think as part of HRT they want either the mirena or utrogestan (which I am fine with).

I would give it time. I had heavy bleeding for about 3 months (take iron to help with the fatigue), it started to ease off but not stop. We upped my oestrogen a bit and low and behold the bleeding stopped. The women's health nurse said that she often finds women who bled heavily before mirena take longer to settle on it, than women who didn't. And we should give it 6 months. Speak to your GP, but if not your actual GP, check in to see if you can access a women's health lead before making any changes. I wasn't sure for months, but I am really happy with how my symptoms have settled (also did not get on with mini pill or injection previously).

I’ve always had light periods before though so was not expecting the exhaustion of this much bleeding (if that’s what the exhaustion is, GP suspects it’s this plus hormonal havoc). Based on what you’ve said, I’m the outlier of someone who doesn’t naturally have heavy periods but the Mirena has caused it.

Thanks for the suggestion of increasing my oestrogen - that’s a definite possibility as I’ve been on the 75 patch before but felt it didn’t make a big difference to the 50 so dropped back down.

The nurse suggested a coil to me as I have horrendous periods, but I've heard too many horror stories. It's all so complicated.

My gynae has now added utrogestan (three months at 100mg daily) to my HRT mix to try to stop the bleeding as I’m so exhausted and she agrees with my GP that it’s probably caused by the bleeding rather than a direct impact of the mirena coil. If this doesn’t sort the fatigue and bleeding I think I’ll have to give up on the coil though - I could cope with the bleeding but not this fatigue on top.

How did you get on with this? I’ve just had a copper coil replaced with Mirena due to crazy heavy periods. I need it for contraception and HRT. It’s only been a week but I’ve been bleeding constantly and I’m mid cycle. Did the utrogestan help?

I had to get it removed, it definitely was impacting my emotional state as well as the constant bleeding and fatigue, and while the utrogestan helped I was still not myself. The GP was very supportive that it just doesn’t work for a small number of us. On the plus side I’m back normal now, it only took a cycle to get back to myself.

I almost had mine removed a couple of months in as i had bleeding and pain, but persevered as can't tolerate oral progesterone and really wanted to use oestrogen gel. By 6 months I felt fine and 1 year on I'm so pleased I persevered. I don't have any bleeding or pain at all now. I think you need to be sure the fatigue isn't related to something else. It could just be a coincidence that it started at the same time as you had the coil.

Oh, just seen your update xx

@KeeepWalking it definitely wasn’t coincidence and my GP said it’s a known side effect for some (a small but significant percentage of) women. The debilitating fatigue was definitely due to my body not coping with the hormones and impacted my ability to function, I’d say I was heading to depression. In contrast, I’m fine with oral progesterone, just have intermittent spotting which is why they wanted to try the coil. I really expected the coil to work for me and had been optimistic as a close friend loves hers - but for me it was horrible.

Thanks for the update. I’m really glad you’re feeling better now. I’ll give it a bit longer before I make a decision. I am definitely fatigued but I’ve been bleeding constantly for 3 months at this point. Ugh

Sounds like the right decision op

it’s early days - I had mine put in a week ago- but I’m just having really bad cramping with a period, worse than it’s been in years

I was advised to have it for adenomyosis (sp?) which caused very heavy bleeding, but no actual pain

I do have several friends who now have virtually no periods. Hoping it works out.

Hope it gets better for you. That sounds really tough going. I was told 3-6 months for everything to settle down.