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[chattygal]

Does anyone else get random spotting,when they have a Mirena as part of their HRT regime? I had it fitted 3 years ago and use Oestogel daily. I've had scans and various gyno checks and all is ok but still get some pinky brown discharge at various times. Apart from that all good.

[Hurdity]

Could it be that your lining is overthinned? I see from your previous posts that you are using a low dose of oestrogel because you are mid 60's. The dose of progestogen in the Mirena is quite high and can cope with quite high doses of oestrogen to prevent bleeding - after all it can stop periods in fertile, ovulating women!

If the endometrium becomes overthin (endometrial atrophy) then this can lead to ulceration and spotting.

If you have been checked out for any problems and all is OK - could this be the answer? What was the actual report about your endometrium after your most recent scan? If the gynaes are just looking at thickness then perhaps they were just interested in a threshold thickness and if you fall below that this would be deemed to be OK ( since it is thickened endometrium which can lead to cancer).

If this turns out to be the case then increasing oestrogen slightly should stop the bleeding.

Hurdity x

[Dancinggirl]

I had the Mirena in post meno for 4 years - got slight spotting now and again and I think this is quite common.  Dg x

[Patricia]

Hi ladies - hope you don't mind me jumping in on this Chattygirl.

I am 62 and recently had my 2nd Mirena fitted. All through my time with the first one I had random bleeding but kept persevering. I believed it was because my womb lining had been 12mm and this was the Mirena working and I was shedding the lining.(gynae said).  I also took 2mg Elleste solo.  With all the fuss about coming off at 60 etc the gynae (at meno clinic) ) suggested reducing dose ......so really for the past few years I have been all over place with moods and symptoms., cutting tabs in half and even quarters.  Last trip to gynae at memo clinic in January she seemed a bit exasperated with me and just left It with me really....I'm guessing she might even be a bit flummoxed herself with the turn around following the NICE guidelines last November.

I haven't been idle though - I've been in touch with dr Currie who suggested Estrogel as it would be easier for me to regulate ...I discovered a wonderful young lady doctor at my surgery who has been patient with me  - so far! She even said she would fit another Mirena for me if the gynae wouldn't but I went privately to a gynae who removed my old Mirena And fitted my new one. she also did yet another hysteroscopy and said a polyp which was found the last time (about 3or4 yrs ago) had gone and my womb lining was 5.1mm. She was also pleased with the condition of everything 'in there'.  She was only young and even chatted to me about coming off HRT but was very respectful when I said no thanks. 

I'm still not right though!  I don't seem to be doing as well as I would like on the Gel.  I have used HRT for 20 years now so I know it can be wonderful but I'm realistic enough to know I won't ever feel that good now I am 62 but something isn't right yet - I was in with the GP yesterday crying !!!! I remember vividly doing the same thing in a GP's office when I was in late 30's but now I know that was the beginning of peri - and I got myself a pregnancy test at the time.🙄

Anyway - the point of me joining in this thread was something you said Hurdity regarding increasing Estrogen - which is Estrogel yes? - you suggested increasing which might stop the bleeding.  Yes, I am still randomly bleeding with my new Mirena - there is a complication though. I am on Warfarin so what would normally be slight spotting is a bit more than that for me. I am about to start my 3rd canister and sometimes I have used an extra blob (prescription is for 2 a day) but I imagined the more I used the more likely I was to bleed?  If it isn't then I think I'll up my dose then and see how it goes.

The point is though, if I felt good I would put up with it now.  This negativity and misery is awful. The health anxiety is sky high.   I have just had loads of  blood taken to test for a variety of things. The GP is really trying and I need her to stay my friend 😂 Before she decides that I am really trying ☺️

Sorry to have hi-jacked your thread Chattygirl - maybe there is something in this 'production' that rings true with yourself?  I await your words of wisdom Hurdity .....thank you Patxx

[Dancinggirl]

Hi and welcome to MM Patricia
I am 60 and had POF so have been on and off HRt since my mid 30s.  Like you I had a Mirena fitted in my 50s which was my best option at the time and used 2 pumps of Oestrogel each day alongside. 

When I had a Mirena removed at 58 I took a one year break from HRT - life had been very stressful at the time and I struggled with the meno symptoms.  I then went to see a gynae privately who put me on Oestrogel with Utrogestan but I found the Utrogestan gave me problematic bleeding (I tried it both sequi and conti) and I actually felt rather sedated (almost high) on the Utro, also got a lot of cramping, so this is why I have stopped HRT again.  I do use Vagifem (local oestrogen) as VA and bladder issues are an ongoing problem.
I stopped the systemic HRT about 6 weeks ago and I'm actually coping OK. The hot humid weather has been challenging but I almost feel relieved to be free being on HRT - I have always felt HRT has to bring more benefits than side effects. I am in a calmer place in my life so doing a lot of walking, meditation etc. - trying to eat well and if I've had a bad night I try to take it easy instead of pushing myself as I used to. I work part time as a tour guide which also gives me some flexibility and keeps me active.
If you are on Warfarin I am surprised they are allowing you to continue with HRT - I thought blood clots were linked to using HRT!! Warfarin might also to the case of your bleeding as well?
Dealing with low mood and anxiety is particularly challenging and I believe one needs to implement a range of measures to control this - I'm afraid HRT can only do so much.
I know many women need an SRRI alongside HRT to help with low mood.
I hope your GP is testing for Vitamin D, B12 and iron deficiency?
I would certainly have a good look at your diet and exercise regime to see if things could be improved.  Maybe consider trying an SRRI, possibly some CBT but also try 3 pumps of Oestrogel per day to see if it helps.
DG xxx

[Patricia]

Thank you for getting back dancing girl - I hear you loud and clear.  The diet and exercise area is covered and my husband looks very well on it!  I'm afraid we aren't quite there yet regarding living a calmer life.  Husband has his own business and all that that entails and he lives life like speedy Gonzales.  I always say he is the warrior and I am the worrier.  So back in the day I had a go with CBT and I also tried group therapy.  Nothing can get you away from yourself though and that is why I am so grateful to HRT for keeping me reasonably sane over the years. 

Now I have come to this age I find I am still struggling.  I already have B12 jabs every 12 weeks.  One of the blood tests is for Vit D as well as a variety of other things.  I will try upping the gel just to see.  It might be that I have come to the end of the road with HRT 🤔 But I will have to have something else just going by the way I am feeling now - if somebody said boo to me I'd fall apart - pathetic I Know. 

Yes- I hear you regarding the warfarin too.  I've never kept that from any medics I have seen. The only time it has been referred to was when I had the recent hysteroscopy the gynae wanted me to stop the night before but said I could resume the day after.

Anyway thank you dancing girl I will report back if I ever discover the magic formula patxx😀

[Hurdity]

Hi Patricia

Not sure about wisdom - those of us who have been here a while just like to help based on our own experience combined with what we've read in the (scientific/medical) literature, as Dancinggirl has just done

Sorry to hear you are still struggling. I would disagree though about increasing oestrogel at your age if you are 62. I would stick with no higher than medium dose if you can bearing in mind that some women achieve estradiol levels of 600 pmol/l with this dose!!!

I am not clear why you changed to estrogel if you were happy on the Elleste solo tabs - except that at our age (I'm 63) transdermal HRT is thought to be safer) - but there was no need to cut tabs in half as Elleste comes in a 1 mg strength. I would agree that using 0.5 mg oestrogen would probably be too low to warrant a Mirena though and could lead to the atrophy I mentioned.

If your lining was 5 mm when measured very recently (how long ago?) then that is OK and I don't think would be atrophied - which would be something like 2 mm or less so I have read. I don't know enough about Mirena to say whether even at 5 mm it would still be shedding with added oestrogen (but bleeding is supposed to stop after 6 months) - personally I wouldn't have thought so - but I'm not a gynae! There must be an equilibrium point when using a Mirena, where the oestrogen dose is just right to maintain the endometrium at a thickness that is not too thick ( so doesn't shed) but not so low that the progestogen causes endometrial atrophy. However no-one can say for certain except having another scan.

Also because of the great variability in absorption of gel what one woman "gets" with 1 pump can differ by a huge amount to another woman's level.  I would have thought 2 pumps would be approx equivalent to 2 mg - but of course you can't necessarily compare due to absorption differences as I said. How long ago did you change to gel and how long were you on 1/4 tab ie 0.5 mg?

I'm rambling and probably not being very helpful - but just a few thoughts!

Hurdity x

[Patricia]

Hi Hurdity - I had been on 2mg Elleste solo.  So by cutting in half then a quarter I was attempting to wean off as gynae suggested at meno clinic....because of my age!   Had done well to get over the age of 60 still on it but anticipated she would want me off it when I went back to her this Jan to have Mirena removed (it was due). I had hoped that Mirena and low dose would do nicely but to be honest as I was tweaking it for previous 18 months or so the misery gradually returned.  And with reference to thread title, I always had intermittent bleeding with Mirena but even then I thought it was all the messing about with the tabs.  You don't realise how well you have been till you become that wreck again honestly.

So being back to my normal miserable self - which I hadn't been since my late 30's/early 40's - I was getting a bit desperate.  I just wanted a professional to advise me and not just dismiss me.  I always check into this site - thank God for it and you lovely patient ladies.  I read about the Gel and how it worked for many ladies on here and I wrote to Dr currie who advised I would be able to regulate it easier....no crumbly tabs!

So now, I had the hysteroscopy in May which is when my lining was found to be 5.1mm.  That was when new Mirena fitted and started the Gel about same time.  The GP and myself reckoned that the 2 pumps is the equivalent to the 1.5mg Elleste solo I was taking by this stage. 

I think I will up the dose by one more pump which will be the same as 2mg. Maybe it doesn't hit the spot quite like tabs but I wouldn't know?

I had biopsy done which okay and I have ultrasound and one of those blood tests are the Csomething125??? Sorry can't remember - to check for ovarian cancer.  Plus lots of other tests - the GP said she would get the lot checked - like a proper health check.  Before long she will get fed up of me I'm sure. She is being so very patient - she filled up yesterday when I started crying!! All she kept saying was but you are only 62 your quality of life should be much better etc So I hope to God nothing is found I'll definitely be hitting the bottle if it is.

Anyway Hurdity thank you for your time - and dancing girl too.  I'll just see how all this pans out. Results due week on Friday and I am to ring the surgery so if I get a call from then beforehand I'm off to join the foreign legion - I know,  I'm a complete wuss. Patxx

[chattygal]

Thank you for all these replies,and to Patricia,never feel you are jumping into someone else's post as it's all information and all interesting to read. As Hurdity pointed out I have Mirena as I had slight thickening of the womb and after discussion with my  gynae we decided this would be the best option for a woman in her 60's. I have used Oestrogel for about 8 months now and use one pump daily which was working well with the random spotting being the only draw back. But the last few weeks I haven't been sleeping so well and have felt a bit tired during the day.  I am going to up the dose to 1 and a half pumps a day and I'll let you know if it makes a difference.

[Hurdity]

Hi again Patricia - I would be interested to hear how you feel on the higher dose. I am intrigued that you are possibly going to be on quite a high dose of estrogel at your age!! I'd almost be tempted to try a Mirena if I could see how an increase in (oestrogen) dose would make me feel - but have always been to nervous of synthetic progestogens - especially all the time! Also chattygal - do keep us posted. I am so glad to read of other women in their 60's on reasonable doses of oestrogen and still with a womb - there are probably more of us than we think!

Hurdity x

[Patricia]

Hi ladies - lovely to hear from you again.  I must clear something up - what a numpty I've been i checked again on my gel canister and yes it does say 1.25 but it is for one pump only and I have been using 2 - that means I have been been getting 2.5mg Estrogel and occasionally a bit more. I have never gone above 2mg in all the years I have been on HRT so that could be why I've not been feeling so good recently.

So Hurdity - don't do it.  Curiously even though I was on the big dose haven't felt wonderful at all and it has made no difference to my sex drive - that's still AWOL unfortunately and requires a lot of effort.

Yes I always home in on the ladies in my age range too.  I wonder if 'over dosing' on Estrogel can somehow back fire and bring back lots of the negative symptoms?  My lack of sleeping, swollen tummy, aches pains and   mood etc is why I went back to myGP  and why I am awaiting these results.  I hope it turns out it is some thing as simple as too much Estrogel that has been causing my problems lately. 

Good luck Chattygirl with this regime.  I'll be back with any info you might find useful. Thank you and you too Hurdity. Patxx