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[jchapma2]

Hi All,

I've only posted a couple of times but thought I seek your advice as just started on HRT oestrogen patches 25mg with a mirina coil.

Just a bit of history, I'm 40 years old and started pretty unwell at the end of 2016, felt very flu like, weak, abdo pain, fatigued, aches and pains, intermittently tearful, brain fog (forgetting words intermittently), hot sweats night and mainly vestibular/balance problems with tinnitus and visual disturbances, dry eyes and tingly face and leg (now thought to be vestibular/silent migraine.  I've had numerous blood tests, Abdominal CT scan and USS, ECG, Chest xray all of which were plumb normal and more recently an MRI head (awaiting results).

My GP's have been brilliant and although my hormone levels are all well within normal limits they are wondering if I am peri-menopausal as I seem to be worse around ovulation and after a bleed.  It has been difficult to work out my cycle as have had a mirina coil for 8 years and had no bleed.  I had it changed in April this year and since then have had a regular bleed (full period lasting 5-7 days) but this can be 23 - 30 day cycles.  My mum and sister were also early 40's when they started the change. 

Prior to last week I had a 6 week period of feeling really well and more like my old self, but I've just started the oestrogen 1 week ago and this last few days feel weak, tired and getting the atypical migraines daily with tingling face.  Very hot at night again and an intermittent faint/warm feeling to face in the day.  Obviously i'm very keen to protect my bones, heart and brain if this is the peri-menopause but i'm wondering how long I should give these symptoms to settle on the HRT before stopping it?

I would be grateful for any advice.

Thanks ladies

[Hurdity]

Hi jchapma2

Sorry - your post got missed - it dropped off the page as quite a few bumped threads....

It's very difficult to say what's going on if you have a Mirena but the fact that you started to have more periods after your Mirena was changed (and especially as it was in for 8 years and would be running low on progestogen - so you would expect to bleed more at this point) when the progestogen given out by the coil is at its highest suggests to me that your cycle has re-started which means your oestrogen levels will have increased. Despite your blood results for FSH (which vary all the time so one reading won't necessarily indicate if you're peri-menopausal) you could have been going through a time of low oestrogen and possibly anovulation - and this would also explain your symptoms.

The fact that you were feeling better and having a bleed even with the Mirena in suggests you could be back to normal for a while. I don't know how adding 25 mcg oestrogen would affect how you felt in these circumstances - it is a very low dose and should theoretically stop you feeling low the few days before and after your bleed starts - but again with Mirena it is difficult.... However tiredness is not a known side effect of oestrogen - it has the opposite effect! Progestogens have a sedative effect.

The only way you can tell what's going on is to stop the HRT and remove the Mirena - otherwise it is impossible I think. Can you keep a diary of your symptoms in relation to your cycle and see if a pattern emerges?

Sorry I can't be of more help. Hopefully now I've answered someone else will see your post and might suggest something especially another Mirena user?

Hurdity x

[jchapma2]

Hi Hurdity,

Thank you for answering, that's a great help. I forgot to say I did get my AMH checked also which shows low ovarian reserve. I'll see how it goes as did email Dr Currie when I was originally unwell and she thought the patch would be worth a try. It has only been 6 weeks of the last year I've felt really well so maybe I've just had a period of normal hormones.

Who knows, I suppose time will tell.

Thank you for your help
Jchapma2