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[Pollie]

I'm so, so fed up and am hoping that the collective knowledge and wisdom of the ladies on here can throw some light on what is going on with me....

I'm sorry it's long - I have tried to keep it simple.

Background:

Mirena used for many years to reduce heavy periods - worked well, periods were light.

Last period feb 2012.

Started oestrogen only hrt patch March 2013 after blood tests confirmed post meno.  Hot flushes stopped.

Mirena removed dec 2014 as 4 yrs old and combined conti patch started. All was well until I had 3 separate heavy bleeds in May, and July 2015.

Hrt stopped in July 2015, investigations done (nothing sinister found just a "proliferative endometrium"), blood tests confirm post meno, severely oestrogen deficient by sept 2015 when mirena fitted again.

Now, about a week after mirena fitted I started Vagifem, the continuous spotting starts. I move on to 75mg patch a month later and spotting increases. 2 months later I reduce back to 50mg and the spotting is lighter but still present. Mirena is changed incase it is faulty batch but no change in spotting. Feb 2016  I use oestrogen cream down below because the 50mg isn't quite enough and lo and behold the spotting increases !

So my question is - what has happened to stop my old regime working any more ?  I have had a stained discharge every day since October last year.  The spotting  surprisingly increases , in response to Vagifem, to topical oestrogen cream applied to my lady bits and to an increase in strength of patch.

Fast track Gyne clinic have discharged me back to gp as they couldn't find anything wrong with biopsies. My gp is lovely but just shrugs and says hrt doesn't suit everyone.

Is it possible that my lining just doesn't respond to progesterone properly any more  if so is there anything I can try as I really need to be on oestrogen. Might a sequi regime work ?

Thanks for reading

Pollie

[CLKD]

Can't help - you need Hurdity for advice or someone using HRT 

[Dancinggirl]

Hi Pollie - I assume you are needing the Vagifem because your VA is still bad???
Are you just relying on the oestrogen patch and local oestrogen to alleviate the burning and other VA symptoms?
I have suffered with burning urethra and VA symptoms for many years and though systemic together local oestrogen does help, I have found that using a moisturising gel is necessary to keep things healthy and reduce irritation. I have used Multi Gyn Actigel every night for many years and this is designed to keep the flora balance in the vaginal area which will relieve burning and itching and stop bacteria and other irritants from taking hold.
I experienced spotting when using Vagifem alongside systemic HRT and the spotting continued even when I stopped using the local oestrogen.  Like you I had investigations and there was nothing wrong and my gynae was baffled as to why I was still getting erratic spotting. 
My theory, and I must stress that this is just my theory as a lay person, is that the uterus simply gets used to constantly shedding.  Spotting and breakthrough bleeding is actually quite normal for the first 6 months after having the Mirena fitted but maybe increasing the dosage of oestrogen stimulated the lining so this may have resulted in it taking longer for the spotting to settle.
I am wondering if it might be sensible to actually stop using the oestrogen patch for a couple of weeks to allow the womb lining to completely shed (keep using Vagifem to keep the VA under control) and then start again with the lower dose patch and leave out the Vagifem if you can bare to. In a way you are rebooting your system??!!
The Mirena is usually the best way to stop all problematic bleeding so I'm sure it will settle in time. Your other option would be to have the Mirena removed and try a sequential HRT but I would try without Vagifem first and use a vaginal moisturiser e.g. Mulit Gyn Actigel or Hyalofemme etc. instead for a while. Dg xxx

[Pollie]

Hi DG

Thanks for your response.

The thought of coming off oestrogen terrifies me ! I was a witch to live with when I came off it in July/August last year for 6 weeks !

The thing is the last two hysteroscopies showed a thin almost non existent lining, so this isn't spotting from the lining being too thick.... And it isn't eratic - it's persistant all day every day.

I think I may well try the sequi regime which is a shame as Mirena suited me so well in the past, oh dear - periods again 

Pollie
X

[Dancinggirl]

Pollie - why not just try without the Vagifem and see if the spotting stops over the next 3-4 weeks first. Once I started spotting I still got breakthrough bleeding even on the sequi HRT.  DG x

[Hurdity]

Hi Pollie

If your lining is so thin as to be non-existent then it could be spotting due to atrophied endometrium and Mirena can cause this - leading to ulceration and spotting. However I would have thought this would have been picked up if you've had a hysteroscopy to take a good look around? Also if using oestrogen is increasing it that can't be the reason.

I presume also the gynae will have checked your vagina and cervix too? I have a cervical ectropion which caused spotting after sex but initially GP didn't think this was the cause.

I definitely would not stop using oestrogen while you have a Mirena coil because of the ultra thinning - and as you say the lining is already very thin. It should settle after 6 months-ish but before that you might well expect increased spotting after increasing oestrogen - but maybe it will just take a bit longer than 6 months? Sorry I can't remember how old you are?

Sounds like the gynaes don't really know why spotting might persist after 9 months ( I think this length of time for spotting is also normal on Mirena).

Personally I wouldn't give up yet - give it a few more months.... perhaps you could try increasing the patch size again at this point and see what happens?

Sorry I can't help further!

Hurdity x

[Pollie]

Thanks Hurdity - the voice of reason 

DG - I am without all topical application so just patch now.....

I will persevere for 3 more months then that will be 9 months as I really want it to work - I think I was just having a funny few days !

Pollie