So you’re in Menopause & you’ve decided that you’d like to combat your symptoms by taking hormone replacement therapy? Brilliant, job done!
Ahem well, probably not actually…
Choosing the right dose & delivery of HRT is an absolute bloody minefield. However, if you get it right this can make an enormous improvement to your side effects. Naturally it’s worth persevering for quality of life but be warned, it may take a while to get there. The tricky part is what works beautifully for one woman may not work at all for another. In any case, it will no doubt be up to you to find your path as opposed to your doctor. Worse still, some symptoms or even bleeding may come back in between trials. When the best part of Menopause is the end of your period, having it return is quite a blow. I know because it happened to me. But listen, dear friends, you mustn’t give up. You’ll get there in the end & it will be worth it.
HOW TO TAKE OESTROGEN FOR BEST RESULTS
Unless you are allergic to adhesives, wearing a patch for your oestrogen is the safest & easiest way to deliver your required dose. I am on Evorel 100 but started on 50 which I doubled up after realising pretty quickly the dose was way too low. It also comes in a 75 strength patch if you’re in between. These patches must be changed twice weekly but others are once a week. It’s a pain in the butt (literally) trying to rub off the sticky residue although a small price to pay for the relief of debilitating symptoms. You can read more about my specific symptoms in this Menopost. Please take time to go through the comments if you haven’t done so already, there’s a wealth of information in them from my readers.
THE MIRENA FOR DELIVERING PROGESTERONE
There are two parts to the HRT story, oestrogen & progesterone. You can take both in one tablet but that’s far from the best form of delivery as I discussed previously in this Menopost. As taking oestrogen increases the risk of uterine cancer we must add progesterone to the mix to protect the lining of the womb.
There are three ways to deliver progesterone – Patch, Mirena & tablet. I didn’t fancy wearing another patch on my body. Finding space to stick a second patch is difficult when they must go below the abdomen and around the midsection. That leaves a small area on my arse & thighs, ah no thanks. As for the Mirena, I needed to do more research before committing to the procedure. It felt way too permanent without a lot more background info.
For the time being, I decided to take my progesterone in pill form. Therefore I settled on Utrogestan 100, a body identical hormone which makes it the safest oral option. Within days of starting this regime, my world was transformed. Not only were my symptoms greatly alleviated, the worst ones like brain fog & severe mood swings had vanished altogether. In addition to that, I had the bonus of sleep due to the soporific quality of the tablets. Huzzah more sleep than I’d experienced in three years!
Remembering a discussion with Leah Hardy, I made the decision to take Utrogestan continually instead of just days 1 – 25. This way there is no return of annoying & inconvenient bleeding – what was formerly known as a PERIOD. It’s important to note here that my Doctor advised against this as it may leave me open to blood clots. However she did not display this concern on her face, quite the contrary.
I read her wry grin & head tilt as code for –
“Well you’ve obviously done your research & know what you’re doing. Clearly it’s your 49 year old body after all, do what you believe is best for you”
Or something along those lines teeheehee…
Oh great lucky me, how fucking fabulous I’m cured. So what do I do? Mess with perfect, that’s what arrrrgh!!!
THE MIRENA & ME
Whilst researching the Mirena three things impressed me most. For starters the progesterone is lower because it is directly delivered to the uterus. In other words orally delivered progesterone is a higher dosage as it’s diluted through the body before reaching the womb. Consequently this presents as another major plus for going with a Mirena, avoiding the kidneys thus protecting them. The third advantage of the Mirena over tablet is it lasts 5 – 7 years. It’s your basic fit & forget.
Sounds like a no-brainer doesn’t it?
Well sure, if it works it’s awesome. But what if it doesn’t? Now here’s the trouble with the Mirena, it can take up to six months to settle. Six months! which is exactly where I am now. It’s easier if I tell you how it went for me, that way you can make up your own mind about it. I’m hoping for the usual high level of comments from readers with experience. This is where we can compare notes & gauge how best to move forward.
Here’s my story so far…
A cervical smear is required before having a Mirena fitted. As soon as the results came back all clear, I booked in for my Doctor to fit the Mirena. The fitting itself was painful I won’t sugar coat it although having a tilted cervix probably didn’t help. Still it’s not insufferable & considering the benefits, definitely worth tolerating for the ten minutes it took to insert. I felt a little sickly in the stomach for a couple of days so I was kind to myself. I left the housework to fester & rested as much as three children will allow. With that, dark chocolate & tea I was back up to speed quite quickly.
Then the constant spotting started… I became annoyed by month three. By the fifth month I was truly pissed off. I suppose I could’ve dealt with the bleeding if that was the extent of it. Adding insult to injury was constantly feeling tired again, back to feeling like a dogs breakfast every single day. No matter how early I went to bed I woke up knackered Grrrrr damn it. So off I went back to my G.P. for a chat about taking out the Mirena & switching back to Utrogestan. My G.P. sensibly wasn’t in a rush to remove it. Instead, she suggested an ultrasound scan to make sure it was in the correct position. Naturally it’s a good idea to check other possibilities before going ahead with an unnecessary & painful procedure. Yet lo & behold the Mirena was exactly where it should be which I confirmed for myself on the monitor. Back to square one.
This time I decided to wait out the full six months it can sometimes take for a Mirena to settle. After all I needed to be sure before making another big change.
SIX MONTHS OF HAVING THE MIRENA
This brings us up to my most recent doctors appointment. I decided to cut my losses & remove the Mirena. But guess what? Yep, it’s still in…HOLY COW!
Six months almost to the day the bleeding stopped entirely although unfortunately I ‘m still feeling ropey & if I’m honest a little meh? What troubles me is the patches are entirely responsible for alleviating these symptoms not the Mirena. Particularly as I’m no longer bleeding. It’s quite possible my body has continued to change over this time & the lethargy has nothing at all to do with the Mirena. However I cannot fathom such a coincidence & have to wonder if my original treatment of combined patch & Utrogestan is worth going back to. Especially as it was so bloody successful, I could kick myself for messing with it.
Then the Doctor had a brilliant idea. Let’s do a little test she said. I’m back on the Utrogestan for six weeks with the Mirena still in & keeping a daily record of my energy level. Genius! This is perfect if I feel fabulous again then that Mirena can go. However if there’s no change we know it’s nothing to do with the tablet & I’ll need to dig deeper for more clues. In which case I shall leave the Mirena for the foreseeable future. Obviously I’m rooting for the former even though the Mirena is the safer & more convenient delivery method for progestogen. I’m past worrying about all that & just want to feel good again. Don’t get me wrong I’m not down on the Mirena at all, it is an incredible device. However if it doesn’t agree with the body it inhabits, it’s completely useless.
Do you have any experience with the Mirena? If so we’d love to hear from you! I know many of you are really struggling to find the right path for your treatment. Rest assured this is a safe place to share your thoughts & concerns. Sometimes talking about a specific issue will prompt a response from another reader that could turn out to be your answer!
Let’s keep this conversation going my loves xx
Comments ( 30 )
Melissa Jones
Hello! I’ve had a Mirena in the past for contraception and like you spotted for months…I felt ok for the first 6 months but after that I felt lack lustre and tired all of the time (a constant brain fog) I gained some weight but the decision to remove it came when I developed hives. My doctor was still keen that I kept it in (they love coils I think) in the end I had to lie and say I wanted to try for another baby!🙄. Fast forward to HRT and I have stuck (literally!) with my first kind Everol sequi …oestrogen 50 and combi patch oestrogen/progesterone. I’ve had a womb ablation so I don’t have periods and my symptoms are mostly controlled by these patches although sometimes I think I could do with more oestrogen but again that would mean a different prog which is where most HRT problems lie. My only worry if I were you would be doubling up on progesterone with both Mirena and Utrogestan…won’t tiredness and any side effects just be magnified ? I would expect to feel worse with both…side effects from the coil plus any from the Utrogestan like tiredness. Some ladies use Utrogestan vaginally which supposedly reduces side effects further although this is off license for HRT but used this way for IVF. I think in the USA the progesterone doses are slightly less each day than the NHS prescibe here so you might fare better when you move there. Mel xxx
MT
Hi Mel! Blimey isn’t that ridiculous that you had to make up a story to get the Mirena removed? I mean seriously that gets on my nerves! And by the way I’m not at all surprised as I’ve heard similar scenarios from other women. So you’re doing great now & that’s the main thing, thank goodness.
About my doubling up – The Doctor doesn’t think it’ll be an issue for the short term. We only need to test if there’s a positive difference & take it from there. Five days on I am less tired would you believe? I’m curious to see it through to six weeks but to be honest, I’m erring on the side of removal already. Thanks for sharing your experience xxx
Simplement Lui
Beautiful and very elegant 😉
https://4highheelsfans.wordpress.com/2018/01/19/king-of-the-heels/
MT
Thank you darling xx
Jane Van Vestraut
Hi! I too have had a Mirena for contraception – many years ago when it was new to the market and I had to practically beg to have it fitted. Embarrassingly I then did not get on with it at all, suffering from PMS type symptoms all month long. The clinic were very reluctant to take it out so, as I had done with a coil in the past when wanting to have a baby, I took it out myself. This is really not difficult if they have left a long enough thread. I am now through the menopause and wish I had tried HRT earlier as I still feel rather lack lustre but think it’s now too late at 65. Jane x
MT
Yay I love that! You’re clearly a woman who takes control of her own destiny Jane 😉
Unfortunately I think you may be right about starting HRT now although if I were you I’d do some research anyway. Even taking a low dose, if it’s safe, may be enough to give you a zing in your step? After all 65 is not old xx
sara delaney
I’m with you – on the whole batch – works a treat! xx
MT
Lovely jubbly! xxx
Emerald
I”ve been on Evorel 50 patch and what you say makes sense. Maybe it’s too low. I have an appointment at the Well Woman clinic here in Glasgow because I’m not convinced it’s the right one. I have swollen up like a balloon and I used to be so skinny. I have no desire mohave too low a BMI, but I certainly want to try something else. I’ll certainly be talking about the need for more progesterone when I go to the clinic.
MT
Ack that’s annoying Emerald. Is it bloating or weight gain? I’m glad to hear you have another appointment, it sounds like your Evorel is too low. You could try cutting a patch in half & wearing one & a half until you get a new prescription. Let me know how you get on?
Keit
Ive never used any of these, maybe because I am still in the safe from menopause. I will however bookmark this cause it’s always good to know how different medication works for different people. I think it is strictly individualistic, as far as it goes, depends on how the body will react. I am taking medication which made me tired all the time too, and I can feel your pain girl, it’s as if you’re beaten with a club on a day to day basis. Crossing fingers you find the golden middle and feel yourself again! <3
MT
Yep that is so true Keit, it really is very individual. I think that’s what many doctors don’t understand, or care to understand about HRT. They seem reluctant to change prescriptions for some reason. As if once you have your meds you should be sorted! I hope you’re feeling better xx
Gail
I’m so glad you write openly about HRT Michelle. On Woman’s Hour this week they said fewer than 20% of women in the UK take HRT, mainly through fear. I’ve been lucky, the tablets my doctor prescribed are great. Been on it for 7 years.
MT
Oh.my.GOD! I did not know that. 20% is so low, tha makes me sad. To think that fear is based on an old assumption that HRT can cause cancer? Well I assume that’s the reason. I know many women are afraid of taking it but I didn’t know it was THAT many. I can’t imagine living a decent life without it & I have no intention of going off it. Just out of interest for everyone reading your comment, what tablet are you taking Gail? Thanks so much for your comment xx
Lynne farrage
Deborah Garlick Is the woman who was on Woman’s Hour this week discussing menopause. She has written a great book on it, is championing a movement to get menopause’ in the workplace duscussed and is an all round advocate for HRT and it’s benefits. I went to an event she ran and one of the stats blew me away. In 1900the average life expectancy of woman was something like 56 and average on set of menopause was 53.. in 2018, average onset is 51 and life expectancy is 81. So 1/3rd of our life I see spent post menopause and evolution hasn’t caugh5 up with that fact. That’s why HRT is so important. We simply aren’t equipped evolution wise, to be without oestrogen in our body for 30 years
MT
That’s right! When you say it out loud it’s so obvious, how have I not realised this before? Thank you so much for sharing this exquisite statistic Lynne, it packs a punch alright 😉
I’ve just popped over to Deborah’s blog & am now following her on social media too, she’s brilliant! xx
Karen B
Brilliant post, just came across your blog by pure chance. I have literally just ordered that book by Leah Hardy as I am getting a bit desperate and even the gyno at the hospital seems to be keen for me to read up on things and suggest them to him !!! I am 55 and have tried three lots of combined HRT tablets all with either no effect or adverse effects such as weight gain, pelvic pain. It was with interest I read about Utrogestan and will do a bit online reading/research about this hormone. I have more or less gone through the menopause, but have had mood swings, energy highs and lows and brain fog and terrible sleeps for a couple of years now. I foolishly thought a year ago a trip to the doctor would solve this straightaway ha ha !!! I may consider hormone patches but with sensitive skin I think the last thing I want to add to my list of issues is an itchy sore body ! Thank you so much for this post and for everyone being so honest I feel happier for reading this and will now not give up on the quest for some treatment. p.s. is anyone taking supplements branded for the menopause ? there seems to be good reviews of various brands and the B Vitamin mix sounds appealing.
MT
Thank you so much for you comment Karen! It gives me such joy to read when someone has appreciated a menopost. I’d love to expand to a podcast one day. I believe there’s a tonne of awesome untapped info out there just by chatting with other women! It’s crazy to not collate it all for future generations.
As for the supplements, I personally saw no imporovement at all when I took them in the first year. I know many women swear by them but I’ve not dug deep into that area. Perhaps I should write a post about it? I’d have to do a hell of a lot of research first but mostly it’d be a forum for comments. Lemme get working on that xx
Zeena
I have had a very similar journey. I was on hrt estrogen patch 100 ( estodot) and 100 utrogestan (progesterone).
I had intermittent bleeding and my Gynocologist suggested I get a Mirena inserted which would help stop the bleeding.
Six months on and the bleeding has finally stopped however I have pelvic inflammation, abdominal pain, mood swings, hot flashes and hair loss!
I have decided to remove the Mirena as it is a Synthetic Progestin and causes alopcia in 5% of women. Thankfully my doctor has agreed to remove it. Hopefully I can restore the damage caused by Mirena.
MT
Wow I’m floored by the similarities of our experiences but perhaps I shouldn’t be?
Why oh why is menopause still such a mystery? Going through the myriad of symptoms, both physical and emotional is utter hell for so many women yet we’re expected to just grin and bear it.
I was ill prepared for the months of bleeding recovery after my Mirena was removed. Please be kind to yourself Zeena and be patient. You might be fine in a couple of weeks, but the bleeding might last months. Remember to get checked if the bleeding is prolonged and good luck!
Best wishes, M
Maria | passion fruit, paws and peonies
My hrt journey mirrors yours Michelle! I keep thinking I’ve got to get his darn thing out of me. I’m still bleeding from the coil after well over 6 months. It’s still uncomfortable and I still feel rubbish. One thing that helped me a little however is reverting back from 100 strength patch to 75 but with 2 oestrogen pessaries a week. Obviously I have a hind of a rhino – because for some reason I’m not absorbing enough hormone through my butt. xxx
MT
I hate to laugh but Maria, seriously “hind of a rhino” had me in stitches 😉
We’ve gotta laugh right? Or we’ll cry waaahhhhhh!
Now onto that darn Mirena/Coil…So I had mine removed the day before we flew over here to the U.S. 7 months on, I just knew it wasn’t right for me & I didn’t want to risk any issues removing it in the U.S. I knew it was a risky move, what with the 8 hour flight but hey ho, I weighed the pros & cons & that was that.
True to form, the nurse DID NOT want to remove it & tried to talk me out of it. I don’t know if you’ve heard this (I have) but many women find a great resistence when they decide to remove the Mirena. It’s absolutely outrageous! I had three appointments before I finally stood my ground & insisted it be taken out of me!
Naturally, I have a whole blog post in me dying to get out about this.
Unfortunately it appears the Mirena is not for everyone, as great as it is for many, some of us just don’t get along with it. I’m doing better now although still a little spotting from the removal. I’m convinced I made the right decision, it’s unfortunate that my GP wasn’t very supportive however I do believe it’s up to us to find what works best. There’s no doubt with the vast differences of symptoms, the reactions to various treatments will certainly vary too. Stay strong Maria, you’ll get there xx
Emerald
Adding to this conversation a good few months later as it may be useful. Remember I wrote I’d swollen up like a balloon? Well, the specialist here in Scotland put me on an oral pill called Kliofem which I imagine has sped up my metabolism because I’m down to about 62kg. Yippee!!! I need to go back and see her next month, plus my GP insists on regular blood pressure checks which is a good thing.
As I said, I have no desire to be as slim as I was since I did weigh less than I should. And that’s not always good for us when we get older. But I’m very happy to be what I am right now (height 163cm). I imagine the higher dose of oestrogen has sped tho he up a bit. However, the specialist at the clinic wasn’t too impressed when I asked her about bio-identical hormones. In fact, she was a bit traditional and said that we “all put on weight as we get older”. But I just wanted to know why an active person would do.
Hope this helps. X
MT
YES! This is brilliant info Emerald thank you for taking the time to add it as this post gets regular visits. I’m probably due an updated Menopost actually, you’ve just inspired me to write one! xx
Lucy Russell
Hi
I’ve just come across your blog, it’s great, thanks for sharing with us.
I wanted to ask a question re evorel patches, I started with 25mg about 2 years ago and recently have upped them to 75mg patches as I was having a few night sweats again and also digestive issues, terrible bloating and gurgling stomach. However upping the patch strength doesn’t seem to have helped the bloating at all. Have you experienced this with patches or is it just me? I don’t know anyone else that does and a lot of my friends use the patches too.
Thanks
MT
Hi Lucy, I’m still using the Evorel 100 patch but had the Mirena removed which you can read about in this post https://www.michelle-tyler.com/2018/07/25/what-causes-post-menopausal-bleeding/
As for bloating, I wouldn’t discount diet and stress. Whenever I experience bloating and constipation it always comes down to my diet going off track. When my stressors are triggered I get lazy and eat too much salty and sugary foods (usually cake and corn chips) but the funny thing is I don’t really notice until I become bloated after a few days. Then it’s like a light bulb moment and I reset to my usual healthy plant based diet. That generally takes a week to feel better.
What is your diet like? And have you considered a plant based diet? I wrote a detailed post about my family switching to plant based, if you’d like to look into that. I honestly believe salt and sugar are woefully underestimated drugs.
Let me know how you get on,
Mx
Maggie
Hi Michelle,
Loved your open and honest approach to the menopause. I had one fitted under general anaesthetic whist having an hysteroscopy. ( tilted womb, another story!). My already bad mood plummeted, so I went to the sexual health clinic and had it removed a week later, no questions asked. My biggest problem has been mental hell ever since. Now I think it might have been the anaesthetic. Maybe you could do a post on mood.. All the best
Maggie
MT
Oh no that doesn’t sound good Maggie, I hope your mood has improved. I did a post on anxiety that might help you. I’ll link below. If there’s anything I can advise, it would be keep pushing until you get what you need.
Lots of love, Mx
Anxiety & the Psychology of Menopause
Bbb
Hi MT, just found your blog in a desperate search to find advice, I have never taken contraception…so didn’t want HRT. I am 47 – not had a period for 2years 3 months and now my brain fog/anxiety/bloated=weight/gain/fatigue is awful. I am desperate and will try HRT now. I work full time in sr management and I feel exhausted. I work out three times a week and eat fairly healthy apart from chocolate biscuits with a cuppa to keep me happy. I am in Glasgow and wanted to ask where the Well Women Clinic is and how did you get on with it… I would even pay at this point as so desperate.
MT
Hi BBB, I’m so sorry this is such a late reply to your question. I’ve taken a hiatus from blogging so don’t check my comments regularly. Anyway to answer your question, I’m afraid I don’t know where your nearest Well Women Clinic would be although I’m guessing you’ve Googled it by now?
With your severe symptoms, it’s really a good idea to have your hormone levels checked. In all likelihood there’s an obvious imbalance that you can easily address with HRT. Mine are bio identical which is a much better way to go. Also it may interest you to know that recently I had light but constant bleeding for about a month. My gynecologist did a hormone check and everything was normal however she recommended raising my estrogen dose slightly, which I agreed to. Guess what? Bleeding stopped and the lethargy I was also experiencing, went away.
Hope you’re doing better my friend and do stay in touch xx