Hi again monsterfromid
You are probably a little confused by now, but it is really quite simple - re the oestrogen and progesterone balance issue.
Rest assured that you do need oestrogen and that after menopause, without supplementation you will eventually remain in an oestrogen deficient state for ever, with many potential negative health implications.
Unless you go completely mad and take or apply well over the prescribed dosage of oestrogen (oestradiol), you will not have too much per se. Only very rarely do women using gel (often after hysterectomy or early menopause) achieve what is known as "supraphysiological" levels of oestradiol ie much higher than ever occur naturally.
In terms of balance - Firewalker is right - and as I mentioned earlier, the more oestrogen you have, the more progestogen you need - but this is simply to protect the womb lining from building up. Oestrogen dominance I feel is an unhelpful concept, not generally used by the scientific world because it implies that only the relative level of oestrogen and progesterone is important - which is true in terms of the womb lining, but elsewhere in the body as I said above - the absolute level of oestrogen is important to your general well-being.
Synthetic progestogens do not have the same effect as bio-identical progesterone, except on the womb-lining and I understand that the synthetic types have more adverse effects - they stimulate other receptors in the body.
After menopause there is no indication for having progesterone only and certainly not a synthetic progestogen which could do more harm than good. There would be no need to have a Mirena after menopause if you do not take oestrogen and results have shown that this can cause excessive thinning of the uterus lining and sometimes ulceration and bleeding.
During the menstrual cycle the relative hormone levels cycle between "oestrogen dominance" during the first half of the cycle, when most women feel at their best, to "progesterone dominance" during the second half of the cycle when most women suffer from pms symptoms to some degree.
The above I understand as the accepted scientific view.
Have you thought of having the fibroids removed - as they were there before you started HRT and the Mirena is not controlling the bleeding, it does sound as though you do need something done here. If you were able to have them removed safely then you wouldn't need such high progestogen possibly and could try the bio-identical as I suggested?
This is what is say in this site about fibroids:
Fibroids are benign smooth muscle tumours of the uterine (womb) wall and are dependant on estrogen. They tend to shrink after the menopause but shrinkage may not occur, or they may even increase in size with HRT use. Increase is thought to occur in 25% of HRT users and mainly occurs in the first six months of therapy. There is some evidence that transdermal (patch or gel) but not tablet HRT nor tibolone may promote fibroid growth. [ref 24] Fibroid size can be monitored by regular examinations and sometimes by ultrasound scans. There is some evidence that the use of the progestogen releasing intra-uterine system, Mirena may cause fibroids to reduce in size. Mirena is often used in the perimenopause by women who have heavy periods and/or require contraception and can provide the progestogen part of their HRT.
Sorry - none of this addresses your depression but I just wanted to clarify re the hormones. Hopefuly if you can sort out your gynaecological issues which may well be aggravating your situation and affecting your well-being, then get the hormones sorted out, you maye then know what's causing what, and hopefully find a way to feel better!!
Wishing you well
Hurdity x
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