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[Pollie]

I know Vagifem has been discussed to death but I still can't find the answers I need can anyone help-

Spotting is an accepted side effect (accepted by the medical profession that is ! No so acceptable for me lol ) but why and where is it from ?

Is it that the uterus lining is stimulated and if so why does it shed and not just build up?

Why doesn't the progesterone (if you are taking progesterone in systemic HRT) prevent the lining from building up and/or shedding ?

I have a mirena coil fitted and have spotted everyday since starting Vagifem 3 weeks ago

I am now trying just estradiol cream on the outer areas but wondering how long to wait for the spotting to stop.  I have a prescription to resume full HRT (had to have a break for few months) but I don't want to start that until the spotting stops so that I can be sure I know what side effect is what !

Does any of that make sense and can anyone advise?

Pollie

[Dancinggirl]

Pollie - how long have you had the Mirena?  Spotting is a common side effect - are you still using Vagifem every day?  It could be just that your uterus is waking up and stimulated but if it continues this will have to be investigated to be on the safe side. DG x

[Pollie]

Hi DG

Thanks for your reply

Mirena is 4 weeks old and I stopped Vagifem 7 days ago .....

I've just had investigations completed for post meno bleeding. I had to come off HRT a couple of months ago and think this is why VA has caught up with me now. I have had mirena fitted, to prevent further build up of lining ....

I really do think I deserve to get off this particular merry-go-round soon 

[Dancinggirl]

Pollie - if the Mirena has only recently been fitted then some bleeding and spotting would be normal - this will be the initial burst of progesterone doing it's work and keeping the womb lining thin.  I really wouldn't worry - this will probably settle in the next 2-5 months. I doubt the spotting is anything to do with the vagifem now so I'd keep using it if I were you but just twice a week. Once you start on some oestrogen I would start really low - say one pump of Oestrogel each day and keep to this for about 4-6 weeks so it can do it's magic and then increase if you need to.  Oestrogel would probably be your best option (I've used it for many years) as you have control over the dosage.
DG x

[Taz2]

I agree with DG about the mirena causing spotting for the first six months or so. You can read more about how it works here and the spotting is mentioned under Disadvantages http://www.nhs.uk/conditions/contraception-guide/pages/ius-intrauterine-system.aspx

Taz x

[Pollie]

Thankyou ladies for reassurance

This is my third mirena, the last was removed in December. I just didn't have this continuous spotting with the first two. The only thing that is different is the fact I am meant to be post meno and the Vagifem

I will give it a bit longer to settle 

[Hurdity]

Hi Pollie

This is really a continuation/update of the other thread you had on Vagifem and Bleeding/side effects which I had to look up otherwise I would have repeated myself all over again. Maybe you could ask Emma to merge these threads because all the relevant info you gave is on the other one? This one:
http://www.menopausematters.co.uk/forum/index.php/topic,29254.0.html

So - to re-iterate what I said on there when you gave your detailed history - you may not be post-menopausal. If you are due to have another period then this could definitely cause spotting in the absence of added oestrogen ie due to your own cycle.

However you said the endometrium was classed as very thin in September so the other alternative is that it has atrophied (due to the effect of progestogen from the Mirena in the absence of oestrogen - if you are late in the menopausal transition) which can also cause constant spotting - so if this is the case it's not the built up lining shedding - it would be the progestogen causing disintegration and ulceration of the thin lining that's there.

Nothing to do with the Vagifem - keep on using this. It cannot stimulate the endometrium if you have a Mirena, and in fact only rarely stimulates the endometrium to an appreciable extent in the absence of progestogen, as the oestrogen dose is minute.

If you are having menopausal symptoms and the biopsies and scans are all clear ie no fibroids, polyps or abnormal cells, then I would suggest your doc should start you on oestrogen asap. If the spotting is due to ulceration and atrophy then it will stop. If it's due to the fact that you are not post-menopausal and still producing your own oestrogen - it should stop as the others have said. My view is that it will stop eventually anyway if you re-start oestrogen, but may not stop if you don't!!!

So don't wait until the spotting stops because it may not!!

Start that oestrogen! What dose has been recommended and what mode of delivery - I can't remember?

Hurdity x

[Pollie]

Hi Hurdity

I repeat myself too much - my children complain all the time - another meno symptom 

I hadn't thought about atrophy at all, that could well be it ! my lining was thin when mirena went in and I had a private blood test last week and my oestradiol was too low to be measured.....that all makes a bit more sense

Still curious how/why spotting is a listed side effect of Vagifem though

I have asked for estradot 75 patch but when I went to my local pharmacy she said they don't stock it as they never get asked for it and suggested I try a larger boots which I can do today hopefully there aren't any problems sourcing it at the moment.

So. If I start on my patch and am still spotting in 1 month 2 months 3 months  6 months (?) when do you think  I should worry ? I know you're not a gp but you give such good advice and have such good understanding I would be grateful for your opinion   

Thanks so much

Pollie

[Dancinggirl]

Hi Pollie - As always, Hurdity is a mine of practical advice and support and I think she is absolutely right about getting on with the oestrogen. I'm surprised the local pharmacy wouldn't fulfil your prescription - they should be able to get it in within 24-48 hours!!! Anyway, a larger Boots should be able to do this for you.
Spotting should settle - I wouldn't worry.  Keep us posted.  DG x

[Hurdity]

Hi again Pollie

I didn't say that Vagifem never caused spotting - it is listed as a side effect so presumably in some cases especially those women who have been without oestrogen for a long time, spotting does occur. Also I imagine that spotting could occur for some women with fibroids (which shrink in the absence of oestrogen) in post-menopause due to sudden stimulation. Fibroids are more likely to bleed than the general endometrium.

What I was saying was that in your case it can't have anything to do with the Vagifem as you have a Mirena and the tiny amount of oestrogen from the Vagifem could not cause spotting as the Mirena is so effective. Sometimes in extreme cases of VA the very act of putting the Vagifem in can cause trauma to the vaginal walls which also shows as spotting - but this would be a different type - and also once the two week loading period has been completed the vaginal tissues should be pretty well plumped up!

I did mention atrophied ensometrium as a possible cause of bleeding on the other thread!

Why don't you start with 50 mcg patch as 75 mcg is a lot to take all in one go if you've been without it. Increasing slowly should minimise side effects - and you might find that actually now 50 mcg is sufficient to eliminate your symptoms?

Hurdity x