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[Dancinggirl]

Hi hoping4best
Thanks for filling me in - you may have mentioned all this on another thread/post which I missed.

I think oestrogen gel is available in the US but probably called something else???

If you have had problems with your womb lining then a Mirena may well be your best option and would allow you to continue with local and systemic oestrogen in any dose you need without the problems that other progesterones give - simply less hassle overall. Here is the UK the Mirena is a favourite amongst most gynaes when it comes to treatment for problematic bleeding, fibroids, polyps etc. - it often solves many problems and can be ideal when part of a HRT regime.
Having had POF myself, I fully understand your dilemma and finding the most effective HRT option is challenging. 
I wouldn't rule out changing to a different progesterone e.g. medroxyprogestone or dydrogesterone -  I found Prometrium(micronised progesterone) gave me problematic bleeding and more side effects than other synthesised progesterones. I used Dydrogesterone for 10 days each month through my 40s and found this excellent - sadly they have withdrawn this as a 'stand alone' progesterone here in the UK, for some strange reason!!?? - it's only available in combination with oestrogen in the Femoston range of HRT pills.
I hope you find a good way forward - you sound very sorted and approaching this whole thing in a very practical way so I'm sure you'll get there.  Just keep in mind that nothing will be perfect - we can't expect to feel good every day of the month so some compromises will be necessary.
I'm 60 now, so have had nearly 25 years of HRT  - have tried most things. 6 months ago decided to stop systemic HRT ( I'm doing OK) but I am use still using local oestrogen and will do for the rest of my life.  DG x

[hoping4best]

Dancinggirl, thank you so much. This is incredibly helpful. One year with insufficient local estrogen and I got stage 2 pelvic prolapse and vaginal atrophy and it was awful, so I am absolutely sold on using local estrogen for the rest of my life.

Because I've had so much hair loss since I started HRT, I've been terrified to try any other progestins that are androgen-derived, including in the Mirena. But I'm now realizing that it may stay local enough to my uterus that it's affects on the rest of my body may be minimized. I hope. Years ago I had 2 different tries with a copper (hormone-free) IUD, and my uterus bled 3 weeks per month on it--my uterus just kept trying to jettison it. I fear that will happen with the Mirena, too, but I'm ready to try, I think!

[Dancinggirl]

The Mirena will result in slight bleeding or spotting for the first few weeks but I found after that it was very little trouble.  Unlike the old fashioned coils, it releases a low dose of progesterone locally thereby keeps the womb lining thin and, for me, stopped cramping etc.
Re: hair loss.  when on synthetic progesterones, did you just get hair loss or did you also get more hair growth elsewhere. If there is a true androgenic effect then one usually gets more hair growth around genitals, nipples, legs, arms etc.
When I tried Tibolone, the androgenic effect made hairs grow around my nipples, pubic hair got thicker and I broke out in spots. I'm wondering if your hair loss thing could be other factors - have you had your thyroid function tested recently?   The hairless could be more to do with thyroid!!??

The US MM site gives different info for HRT types and I don't know whether it includes this rather useful info on the different types of progesterone: 
Testosterone derived - Norgestrel, Norethisterone acetate and Levonorgestrel.
Less testosterone related - Medroxyprogesterone acetate(MPA).
Least testosterone related - Dydrogesterone and Micronised progesterone (Utrogestan).

I wondered if you had tried Medroxyprogestone (MPA) or Dydrogesterone?

Also: Here is the UK info on the Mirena:

MIRENA
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )

With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
Price: £88.00

Hope this is helpful.  DG x

[hoping4best]

I have never tried synthetic progestins yet. My hair loss kicked in about a year into POF, when I started higher dose patch and oral utrogestan. It seemed to get worse when I added a little topical T for a month or two a couple years ago, but that could have been a red herring.

For hair loss, I've been tested for everything: thyroid, adrenals, vitamin deficiencies. It's all normal and my T is always very low. I have lost body hair along with scalp hair (mostly pubic...which should be helpful but I find a bit distressing), and my scalp hair is in a FPHL pattern around my part/top of my head.

I go for my first 6 month check at a hair specialist tomorrow to see if/how well minoxidil is working, so I'll see how that goes. Friday I go back to my RE, maybe get a mirena.

Thanks again, DG!

[Dancinggirl]

hoping4best - If you hadn't had hair loss before your hormone levels dropped, I'm wondering if it is partly due to the lack of oestrogen and partly due to your body going into a kind of shock/stress due to the loss of oestrogen. I believe hair loss over the whole body can be caused by many things - one of them being stress. 
Genetics plays a big role as well.
Maybe once you have got your hormones in balance your hair will return as well. Do keep us posted.  DG x

[Cassie]

had to go onto hrt very young age and the gel with a combo of utrogestan 100mg x 10 days is wonderful, ask for the gel, perhaps known as oestrogel or femigel?

[hoping4best]

Cassie, what dose of gel do you use? I'm not sure how the gel doses compare to patches. I'm generally on a 0.075 to 0.1mg patch.


Also, is that oral utrogestan you're taking? I'm on day 3 of vaginal utrogestan and it hurts! The tissue and my urethra are so irritated. 🙁 If I get a Mirena on Friday, I hope the local progesterone from the IUD doesn't cause urethral discomfort, too. Will go back to oral until Friday.

I am asking about the gel on Friday, too.

Many thanks.

[Dancinggirl]

hoping4best
I'm not familiar with patch doses in the USA -  when I tried patches they didn't work for me very well - it sounds to me as though you are using a very low dose patch??!!!.  There are different types of oestrogen gel and your doctor should be able to offer, or tell you, the amount you need to give a medium dose - at your age your should probably be on a medium dose to protect your heart and bones - this would be 2 pumps of Oestrogel per day.
When I tried Utrogestan, I had to use it orally - used vaginally, it really irritated my whole ‘lady bits' and made my urethra very sore.  I think it's the capsule coating that did this and that type of progesterone did aggravate my bladder - I even broke out in a strange rash on my face as well!!!  Utrogestan is, in my opinion, quite challenging as it gave me more side effects than other types of progesterone. Used vaginally it clearly absorbs better but used orally one needs a higher dose (200mg) and this will often not absorb that well and can bring sedation and other side effects. Used vaginally, on a sequential regime, many women find Utro great but I think you are like me and need something different - the Mirena didn't irritate my urogenital area - there aren't any fillers or coatings to aggravate.
Do keep using the local oestrogen (Vagifem) and some vaginal moisturiser e.g. SYLK - I find this great.
You might want to try one of the other progesterones I suggested before trying the Mirena - it is trial and error.
DG x

[hoping4best]

Ok! Hair specialist I saw yesterday is strongly encouraging me to try birth control -- the least androgenic progestin is in Desogen, Mircette, and Cycletta (who names these things?  ). Basically, desogestrel with varying amounts of estrogen. She said she's seen multiple patients with hair loss from Mirena. She gave me this very helpful chart, which others might find helpful: https://www.nhpri.org/Portals/0/Uploads/Documents/NOTE_2_TABS_Contraceptive_Comparison_Chart_01_2012_2.pdf

I've also read that Qlaira BCP has "more natural" estrogen and an "anti-androgenic" progestin. There is some questioning of that marketing though. And my androgens are so low, I definitely don't need a lower libido than my current "none". Sigh.

Reproductive endocrinologist on Friday. Onward!

Thanks again so much DG.

[Dancinggirl]

Sounds sensible advice hoping4best - makes sense to me anyway.  I know many women do well on Quaira so could be worth trying. You will need a good dose of oestrogen though. Good luck with endocrinologist.  DG x