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[Hurdity]

pollie, yes it is strange.  I can only give you my personal experience but I had a Mirena coil from 1998 (for contraception purposes) and before the menopause, I always had periods.  However, my periods stopped while I was part way through my second Mirena coil and I wondered why.  I thought perhaps the new coil had a slightly different formula but it transpired that I was post menopause.  I remember the doctor saying that as I had always had periods before with the Mirena, there was no reason for them to suddenly stop other than the menopause and that is why I had the tests. 

I then started using a 50mcg oestrogen patch with the Mirena coil still in place but I never had a period.  I didn't find the 50mcg patch very effective and it clearly was not delivering enough oestrogen for my needs but I imagine that had I been using the oestrogen gel like I am now, I would probably have built up enough lining to have periods.

I don't know if that explains it.

Re the Mirena

The amount of progestogen needed to oppose oestrogen and prevent the lining thickening is dose dependent - so whether or not you get periods on Mirena is directly related to the amount of oestrogen in your system - either your own or from HRT. Those women with high oestrogen levels and heavy periods - will get lighter periods but they may not stop completely (while they are fertile).

As you get towards peri-menopause and in peri - your oestrogen levels will drop and therefore periods may well stop. However if your periods stop while using the Mirena - this absolutely does not mean you are post-menopause in fact it is most likely that you are not!! It means you are peri-menopausal -  probably will be for a certain length of time which is impossible to determine - could even be a couple of years or more before being post-menopausal. Blood tests do not help because as we know the levels of FSH go into the post-menopausal range even very early in peri sometimes. We have had several examples of women on here being told they are post-menopausal on the basis of a single blood tests - or even several - and one women was told this after one missed period and that she would never have another period - which of course she did very soon!

So - you cannot date your menopause from periods stopping using the Mirena, nor from a blood test. You would have to stop using the Mirena and wait 12 months to see if you were post-menopausal or not!

Hurdity x

[Hurdity]

Isn't it that when you withdraw the progesterone you have the bleed? So with the Mirena or taking the pill back to back you are still having progesterone to protect the womb, but without gaps for the lining to temporarily fall away.

As long as you are having the progesterone then you can have the oestrogen. The bleed is surely just a side effect of having a gap?

You only get a bleed when you withdraw the progesterone if the lining has built up sufficiently. It isn't a foregone conclusion! In continuous combined HRT for example, after the settling in period of time, there should be no bleed if the dose of progestogen is just right compared to the oestrogen - such that if you then stop the HRT you should not get a bleed. If you do then the progestogen dose was not sufficient to do its job properly.

The pill - from what I gather this is designed to have a gap in which you have a bleed (therefore there is excess oestrogen compared to progesterone) so I presume it is accepted that the lining builds up - which is why taking back-to-back of the pills that normally have a week's gap - is not advisable for longer than 3 months. Sometimes a continuous dose of progestogen will continue to thin the lining so I imagine that's what happens with this type of pill - even so I imagine there would be a bleed after 3 months and then a week's gap? Sorry just thinking aloud here!!! Don't know much about the pill!

Hurdity x