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[Ljp]

Hi me again,
Now four weeks since having estring and mirena coil inserted, and starting oestrogel one pump.

I have appointment tomorrow to see my GP as I was only prescribed one canister of oestrogel to see how I got on, plus I apparently need the coil checked, although I'm sure it's fine as I can feel the strings.

My only issue is firstly the spotting (which became a bit more last week, now only light) I will ask her when and if it's likely to stop, as I am concerned as my hysteroscopy done on day of insertion, showed atrophic lining, not sure if bleed would be from atrophy or build up? Is that something she would know?… also slight worry that mirena is progestogen, which from my understanding, is the type of progesterone linked to increase breast cancer risk?
Would utrogestan be safer?

My other query is how to tell if I would benefit from upping the oestrogel to two pumps and possibly remove the estring! Or whether to keep on with estring and one pump?

Any advice gratefully received and will these questions be able to be answered by my GP? Or is it just a suck it and see scenario?

Thank you, probably overthinking, but I'm really good at that! 😊

[Mary G]

First of all, the Mirena coil does contain a synthetic progestin but most of it is confined to the womb and unless you are unlucky enough to be severely intolerant to synthetic progestins like me, the risk of side effects and breast cancer are very, very low.  The oral synthetic preparations carry a higher risk but even that is minimal. 

One pump of oestrogel is quite low so you could consider upping it to two pumps.  The question is, how well do you feel on one pump of gel, has it relieved your symptoms?  Has your bladder problem improved at all?  How is your mood overall?  Sorry for all the questions but your next move depends on the answers to those questions and if your bladder problem has improved, you could then consider having the Estring removed but if it is the same or worse, you may need a rethink. 

[Ljp]

Thanks Mary 😊
I do feel better, bladder is less sensitive re frequency, but urgency can still be a problem. Do feel more comfortable downstairs, as I think the estring has helped plump things up a bit.

Night sweats are lots better, but still have a bit of a surge when I wake in the morning. Mood has improved a bit, as has brain fog, but still there.

Just not sure if two pumps would enable me to stop using estring and control all symptoms better, or if I'm best to come tinge with one pump and estring until three months?

[Mary G]

Why not try 2 pumps of gel and keep the Estring for a while and then decide.  That way, if the bladder continues to improve, you can then consider removing the Estring.  You will probably find the other symptoms will improve or disappear completely with 2 pumps of gel. 

Glad you are feeling better, it sounds like the Oestrogel had kicked in.

Let us know how you get on tomorrow.

[Ljp]

Thank you Mary, if I do that, would it be best to apply one pump morning and one pump night? I currently just do the one pump in the morning

[Mary G]

Yes, I think that might be a good idea in order to avoid a dip in your oestrogen levels.  I do the split dose to avoid the dip during my Utrogestan phase but if I remember rightly, you find it wakes you up at night so it might be better to split your dose too. 

[Ljp]

Sorry Mary not sure I understand, do you mean using the oestrogel at night wakes you up?

In which case would I be best to just use two pumps in the morning?

Obviously my progesterone is continuos from the mirena

[CLKD]

How did you get on?

[Ljp]

Got on ok thank you for asking CLKD. Do feel a bit like I do all the research and almost tell my GP what I think is best etc, and question her knowledge, even though she is menopausal herself ( she's retiring end of March, such a shame as she's been a lovely dr and always refers if she isn't sure of something)

I only had to see her to get more oestrogen gel, as initial prescription was one canister. She said that bleeding with mirena coil is very common for first three to six mo the, while body gets settled. She also agreed that while I have 2 months left of estring use, now would be a good time to increase oestrogel to two pumps, then when estring has run out, I can see how bladder goes without the estring.

I have used two pumps of oestrogel the past two days, splitting it into one pump morning, one pump evening. Can't say I've slept particularly well thought, and last night was very hot, but might just be  mild weather? Or could it be an increase in the symptoms while body gets used to the extra dose?