Periods returning on Mirena Coil/HRT

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Hello,

TL:DR periods have returned on Mirena coil after nearly 2yrs, should I see the GP?

I wonder if anyone else has has this?

I have been on HRT since January 2023, first using utrogestan, then moving to mirena after 6 months. (with 100mcg oestrogen patches and testosterone).

This was great for 7 months then my practice nurse dislodged the mirena doing my smear test. So I had it removed (I kept nearly fainting, so no choice) and paid a private GP to refit a second device a week later.

I was in the process of seeing a gynae about something else and mentioned I had continued to have periods since the first coil was fitted and that I still had bad period cramps. He did a scan, uterine lining was 6 or 7mm and he said that although I was peri, not post meno, he wanted to do a hysteroscopy. I had a hysteroscopy D&C, everything was normal.

I then had a series of prolapse gynae surgeries over the following year but these were not invasive and my mirena stayed in situ.

I have now had this coil in for 19 months and I'm very happy with it and my HRT. I've had very very little bleeding and no meno symptoms.

Except this morning I've just started my second period in two weeks. The last one felt very period like with sore breasts and this time I've got horrific period cramps, just like I used to have pre HRT.

I do sometimes spot a bit, but I've always put that down to my ectropian cells after sex or a big bowel movement. Sometimes after doing weights.

Would you bother a GP/go back to gynae about this? I have spent the best part of a year in and out of the GPs after and because of all the issues thrown up by my surgeries and I think they are probably sick of me, the receptionist even knows my name 😳

Is this pretty standard? Is it a final fling of peri hormones? Or is my oestrogen over powering my mirena? Or ectropian?

I'd appreciate any ideas!

Personally, I'd not jump into anything just yet. The Mirena doesn't always control periods in all women, although it does in some. You may have had periods all along but not heavy enough to break through and cause bleeds.

You're using the highest dose of estrogen so that plus your own hormones is probably why the Mirena isn't doing its job.

There's nothing they can do except offer you another scan. And it's not just the thickness of the lining it's the way it looks that counts - if there are any areas of abnormality (I've had numerous scans over the years.)

How old are you? If you were mid-late 50s and over this would be a concern but if you're younger and in peri, it's different.

@JinglingSpringbells 47. Been peri meno since noticed symptoms about 42 (sweats, flooding periods etc).

Thank you for your view!

I have the Mirena and oral oestrogen. If my periods were to return after a while, whether I was taking these or not i would go back to the GP.

Bloody annoying though. I'd just got used to no period pain, retired all my period pants and stopped considering bleeding when booking holidays!

This is only my opinion and you must do what you want.

However, from what you describe it looks like a case of sometimes you're ovulating (normal in peri) and that contributes to a thicker lining= blood loss. The rest of the time, the Mirena controls the lining apart from some spotting.

You are on a very high dose of estrogen so one option is to reduce that to a 50 or 75 patch, otherwise what you are experiencing is possibly going to keep happening for a good while yet.

FWIW, you might like to know that the Mirena is the preferred treatment for hyperplasia in women post-meno whether they use HRT or not. It's used when women have bleeding after menopause where the lining is unusually thicker and can possibly become cancerous.

Your GP would probably send you for another scan which won't be of much use if you are ovulating as the lining will be thicker at some times of the cycle.

Have a think over what to do.

@BunnyRuddingtonthank you.

@JinglingSpringbells
My reticence is not wanting to go anywhere near a hospital again after having so much surgery last year. If I can possibly help it. And rationally everything you have said makes total sense.

It was a little niggle at the back of mind, that when I started bleeding again today, became an actual thought process!

I will keep an eye on it for now. The fact that it comes with period pain makes me think that it is just exactly that.