HRT , mirena coil and bleeding

[Merseymum1980]

Im at my wits end with bleeding on hrt
I have mirena for progesterone. I know its defintley the ostregel as i stop taking it and i stop bleeding.
Ive tried reducing dose.
Its getting me down as after a week of stop taking it i get all the crazy symptoms, ive tried the natural alternatives to no avail.
Has anyone managed to stop this please

I am on a similar journey. My doctor also added a high dose of oral progesterone, was still bleeding. I'm now trying duphaston (still bleeding!). As it's bright red blood they reckon there could be another source that's feeding the blood, e.g. fibroids so next step is a scan. Have you had a scan?

I had Mirena and evorel patch 125 also vaginal uttogestan. I was spotting / bleeding constantly . Eventually got a NHS gynae appointment for a hysteroscopy. Gynaecologist said I was overloaded with hormones and to stop the vaginal utrogestan and gradually reduce the evorel patch.
now have Mirena and 25 evorel and all is well.
I would add that I used to be under a very well known private HRT clinic who just kept increasing everything.
I definitely would never go to them again.
try reducing the oestrogen

Whats everol please x

Evorel is the oestrogen

Thank you. Im on the gel. Im wondering whether to try a pump every other day.
I keep trying to go natural but after a week the crazy anxiety, night sweats, hot flushes and bad temper returns

Yes had a scan and no issues. Dr claims that because im peri i might not need the hrt
However i was an absolute wreck before it

My gel is showing as 1 pump is 1.25g or 750 micrograms

I had this. I was on progesterone tablets and oestrogen gel. Had all the scans etc... I switched from doing the gel on legs to the arms and hey presto haven't had a bleed in ages. They wanted me to try coil but I was reluctant so I am on two tablets.

One scan identified Adenomyosis which I suspect might have been the cause of the bleed as it probably interacted with the oestrogen. I think there is less oestrogen absorbed via arms.

Ok i mainly do arms but sometimes leg so maybe il try a tiny bit each day on arms. Thank you

Im on an equivalent of 25 everadol

That's unusual to be bleeding on a low dose of estrogen and with the coil, It won't make any difference where you apply the gel. Putting it on your legs isn't going to reduce the bleeding. if it does all it would show is your thighs don't absorb gel and you'd then get all your meno symptoms back - because 1 pump of gel is very low. You need a scan just to check all's okay.

@Merseymum1980 There is not less absorbed by the arms. If it was, the leaflet would not advise to apply it there. (you personally may not absorb it so well on your thighs but that's very personal and down to your skin.)

If you have adenomyosis that is why you're having a heavier bleed because it increases the amount of womb tissue (like endometriosis) and therefore there is more blood loss.

Scan was all fine. Yes its really srrange and driving me mad x

How long have you had the coil?
They are licensed for 4-5 years for HRT, less than for contraception.

There is one thing to consider - too little estrogen can cause endometrial atrophy where the womb lining is so thin it bleeds.

Using just 1 pump and the Mirena coil might mean you're experiencing this. The lining becomes so thin and fragile that it bleeds/ spots.

If you search for this condition online you should find it.
It may be worth increasing to 2 pumps for a few weeks to see what happens.

You should also be sure it's bleeding from the womb and not the vagina (vaginal atrophy.)

One thing I was told was consistency is very important so sticking to roughly the same time of day. Also absorption can be impacted by the temperature of your skin so if you have recently had a shower etc ..

Has the gynaecologist suggested anything else? A different type of oestrogen for example? It's also possible you might Have something like adenyosis which could be responding to oestrogen. It's very difficult to spot apparently. I had a few scans before they spotted it.

Adenomyosis would respond to the Mirena coil because it would control the growing of the womb lining.

I think if @Merseymum1980 is stopping and starting estrogen that can lead to spotting when it's restarted. There is also the possibility that too little estrogen and too much progesterone (the Mirena is a more powerful synthetic type compared to micronised progesterone) can lead to a womb lining that becomes thin, fragile and bleeds.

Thankyou. This is helpful

I was told 8 years for a mirena for hrt

It's online if you want to check.https://www.drlouisenewson.co.uk/knowledge/the-mirena-coil-everything-you-need-to-know

How long does the Mirena coil last?
The amount of time a Mirena coil can be left in place depends on its reason for use.
If you use the Mirena for contraception only, it is now licensed for eight years.

If you use the Mirena purely for heavy menstrual bleeding, it is licensed for five years.

If you are using the Mirena as part of your HRT, for endometrial protection, it can be used for five years before you need to get it replaced. While the product license for Mirena is for four years for endometrial protection, the Faculty of Sexual & Reproductive Healthcare supports its use for five years.

If you have one, for HRT you should talk to the dr who told you this.

Ive only had it since february

Both time I've had a coil it's taken six months for the bleeding to stop/settle down. I've no idea how taking ostragene would affect this but it could just be the coil.

Ah, that makes a huge difference. I thought you meant you'd been using the coil for a long time.

The guidance is allow 6 months for bleeding to settle. Your GP ought to have told you this.

It doesn't look as if you have anything to worry about.
What you're experiencing is normal.

The 6 months guidance is the same for any sort of combined continuous HRT- whether the progestogen is the Mirena, tablets or patches.

www.menopausematters.co.uk/postmeno.php

When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy.