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[wyvern]

HI Everyone..I could really do with some advice and help please, and I apologise in advacne for becoming emotional in this, and for it being a long post.

I'm 50 and have had 3 Mirenas for heavy bleeding over the last 16 years. 4 years ago I was having issues with mood swings/ irritability, night sweats etc and went on 25, then 50mg, oestrogen patches, with the Mirena left in situ. The Mirena expired in early 2018, ( and the gp knew this)  but the patches were continued. In March 2019 I has an unexpected bleed and the GP took me off the patches immediately. I saw a consultant in May 2019 and she removed the defunct Mirena and told me to stay off HRT. I had a biopsy at the same time and everything was clear.

I should also add the I have been on low   dose anti depressants for 25 years  for anxiety, not depression. I was having a course of CBT to teach me how to cope with the anxiety and started to come off the pills in Jan 2019. It was a really rough ride, I suffered from lots of withdrawal issues, became very low indeed and was briefly suicidal. I have now been off the antidepressants completely since May 2019.

Once the HRT stopped I had no resumption of the night sweats although the emotional ups and downs and general low mood came back and has worsened ever since.  I had three very heavy bleeds (think new mattress, not going out of the house for 3 days type thing)  in August September and October, but then they stopped. In November I felt bright enough to try sex, which was extremely painful due to my nether regions being dry as a desert. That was kind of the last straw.
I went back to see the GP  who suggested a return to the patches/Mirena combo, though the patches would have to start at 25mg and build up gradually if I needed to...which she though I probably would.

I should say I was in two minds about this. I wasn't happy about constantly looking over my shoulder (as it were) waiting for another unexpected bleed...though I might not have another one perhaps. I had no night sweats, not much brain fog, but  the low mood was worsening ..I had isolated myself from friends and activities, withdrawn into myself  and was often so down  I just wanted to run away. I did  think  about suicide, I just wanted a way out of this constant dark place and feeling I couldn't cope. I thought the oestogen would help with that, which Is the main reason I went ahead.

Anyway, I've now had a Mirena and been on 25mg of patches for 15 days. Its hell.  I've been bleeding heavily for 8 days. I'm having night sweats and cramps every night. I don't sleep, my brain is 'running' all the time. Worst of all, my mental state  is dire. I cry all the time, there is nothing 'good' in my life at all, I've stopped eating, i desperately want to stop breathing and last night  I started to self harm.

Surely it isn't meant to be like this??? It wasn't last time?  Everything is worse and all the bad physical stuff is back too. What can I do?  Should I double up the oestogen  (I have enough patches to double up fr a couple of weeks)?, or just stop using them and rip the Mirena out?  Do I have to just wait??  This morning I am all out of strength and patience. Do any of you have a similar experience and can offer some tips or advice. Please? Do I just have to 'man up' and cope....cos I honestly don't know how any more.

I have a GP appointment (not with someone who knows anything detailed about menopause) on the 14th Feb, which is when we are supossed to be discussing the possible increase in patches to 50mg, but I don't know if I can cope like this until then. I can't get a quicker GP appointment (we have the worst patient to GP ratio in the country and its at least a 5 week wait to see anyone..emergency appointment on the day are rightly prioritised for kids and those who need, and can be given useful, immediate help..ie not long term issues like this). The health service here is broken.  I can't get any professional help and I don't know that I would trust it anyway, so that is why I am asking here.

Just a couple of other things to add to the drama - my mother died in July, my long suffering and very patient husband has now said he  doesn't know how long he can cope with me being withdrawn and cut off from him, and last Monday, out of the blue, my 21 year old son was made redundant from his dream job, and by dream I mean something he had longed for since he was a child and that no one ever thought he would get the chance to do. He has, at a stroke, lost his job, and his friends and the people he admired and looked up to, and in all honesty, has no chance of getting another similar job at all.

And all I can do is sit in a chair, look vacantly out of the window cry and wonder what the hell is going on and when, if ever and how, I can become  'me' again.

[sheila99]

Poor you, you're really having a rough time. I don't know if I can help but didn't want to read and run. Perhaps you could discuss going back on ads until the hrt has settled. It does sound as though you need more oestrogen. If you were on 50 before I'm not sure why they gave you 25? The bleeding is probably a good thing as there will have been a build up when your last mirena expired. Did you have a scan to see how thick it is? You will probably need treatment for vaginal atrophy. Can't help with that as I don't suffer from it but there are plenty of posts on it. If va was your only problem you could just have local oestrogen for that, you don't need to be on HRT for it.

[Kathleen]

Hello wyvern

I am so sorry that you are suffering so much. It seems that your hormones and therefore your emotional state are in turmoil so it's not surprising that you feel the way you do.

I agree with with all of  Sheila's post  and you probably  do need more oestrogen, vaginal atrophy is a definite indicator.

When you finally see your GP it might be worth having your Thyroid checked. I've been researching hypothyroidism recently and it's amazing how many emotional symptoms overlap with the menopause so that's worth looking into.

I'm sorry that your son is having to deal with such a huge disappointment about his job. Is there a counselling service he could contact?  Perhaps one specific to his profession? There may be other related jobs that would help him remain in his chosen sector.

Sorry that I can be of more help and I hope you fee better soon.

Take care and sending hugs.

K.

[wyvern]

Thank you for your replies ladies!

I had my thyroid checked  6 months ago and all was fine. I had an ultrasound last April and there was a small thickening and a tiny fibroid, but nothing else.
I hadn't heard of vaginal atrophy... I shall check the posts for it. Thanks for the heads up

I'm mainly just lost and wondering if this  bleak mood is menopause related, can it get that bad just because of the menopause?  or if it is something else...?  I am just overwhelmed by it and confused by all the conflicting information online regarding HRT and what causes what etc etc. and how to combat the bad and increase the good. And I've never been  a patient person so all this 'give it a couple of months' doesn't sit well with me, especially as it feels rather grim right now

But the sun is shinning.....

 

[vintagefiend]

hi there-
have to be quick but wanted to let you know that i had a dreadful time on the mirena- i did end up removing it myself, but not recommendin that! i need oestrogen and i hate taking progestogens! i'm still figuring stuff out- also have useless gp so just doing own thing though may save up for private. this, of course, may not be your issue but just wanted to let you know how i felt with mirena. hang on in there- so easy to say, i know- that's what i'm doing and figuring out as i go along- menopause matters a brilliant forum- you are not alone.

[Hurdity]

Hi wyvern

 

First of all so sorry to hear the sad news that your mother died - this alone would be enough to cause physical and physiological upheavals in addition to the hormonal turbulence and of course the grief you will still be experiencing. Added to that your son's situation has not helped - maybe start a different thread (in Prviate Lives?) if you would like to talk further about that and any support to give him?

Re your hormones. Looking back at your history - I really don't know why your HRT was stopped back in 2019. If you are not post-menopausal or if the progestogen in the Mirena was becoming less ( which it does over the years it is in place - and especially beyond the licesned time - 4-5 years) then a bleed is ntrual and normal and probably due to your own cycle - or else if not, because you needed more progestogens for the additional oestrogen you were taking as HRT.

OK so when you had the Mirena removed - you had 3 very heavy bleeds. I presume these were likely to be normal periods? With the Mirena in place you can't say what your natural cycle is doing, so in the absence of taking extra oestrogen - this is the most likely expalantion. The fact that you had heavy periods before the Mirena does bear this out?

With the heavy bleeding - no wonder you have cut yourself off - this sounds like the most important issue to deal with. The thing is if you have been having your own natural cycles - and some of these are what are known as anovulatory (no ovulation) then it could be that your womb lining is building up hence the heavier bleeds especially as you are prone to them.

The fact that your lining did show thickening (before the bleeds last summer) means it may well still be thick for the reasons given above. That being the case initially there will be bleeding with the Mirena as the progestogen is causing it to shed - eventually after 6 months or 9 months max you should get either no bleeding or perhaps a small amount if you ovulate. There is information about bleeding treatments on here  https://www.menopausematters.co.uk/periodtreatments.php but as you have a Mirena then they may not be possible and the Mirena will deal with it. I wonder if a short course of a strong progestogen in addition to the Mirena might speed things up ie give you a bigger bleed to shed the thicker lining and mean that you don't bleed and spto for 6 months? I'm not sure if this is ever a treatment protocol in addition to Mirena or not?

Re the dryness - as the others have said - you need to sort this asap! There is a lot of info on this site. look at the main tabs start with this one: https://www.menopausematters.co.uk/vaginalsymptoms.php then look at treatments. Also Dr Currie has written a blog about it - here's the list of blogs: https://www.menopausematters.co.uk/blogs.php

Also back articles in the magazine:
https://www.menopausematters.co.uk/pdf/article-gsm-issue44.pdf
https://www.menopausematters.co.uk/article-vaginal-atrophy.php

Please get help and don;t go through this alone - can you go to someone else and talk about how you're feeling. Samaritans if you are feeling that low and have started to self-harm. Also please start a suppoort thread on here if it helps ( a different one in private lives?). Can you show your husband the information on this site ( not the forum of course!!!)? There is the Man Shed (go to home page) https://www.menopausematters.co.uk/manshed.php which has lots of info to explain what women go through at this time of their ( our) lives.

Re your moods - it does sound like you need higher oestrogen too but I can understand your reluctance with the bleeding. if your doc tries to fob you off with ADs  well done for stopping them but if you are seriously depressed rather than anxious please ask to be referred - also to discuss your whole situation re the bleeding and how you;re feeling. You will be experiencing the worst of the Mirena giving out a high dose of progestogen - which of course you probably did not experience before as you were fertile and having a cycle so plenty of oestrogen to take your mind off any side effects.

This is somewhat of a ramble but I hope you find some of it useful and please please do not despair - continue to post and there is always someone to help (even in the middle of the night as there are a few members across the pond or down under and a few insomniacs and early risers!!).

Take care
Hurdity x 

PS sorry for any typos - I have't read it all through and edited before posting as it's so long!

[wyvern]

Thankyou Hurdity. I'm very grateful for so much information and knowledge....it's just what I came to the forum hoping to find. I do feel a bit brighter this morning having read the responses I've had here. It is such a relief to know I am not alone and that I can get help and advice and support. It has given me a bit of hope!

I will check those links asap.

The  HRT was stopped last year because the bleed was unexpected and apparently I needed a 'lets just make sure its not anything nasty'  2 week consultation at the hospital. The GP thought it was more than likely just because the Mirena had run out and the  oestrogen patches had thickened the womb so my system was just voiding itself as it couldn't take anymore. The Mirena was apparently completely empty (strange expression,I didn't realise they had a 'fill' level like a kettle) when they removed it.

I did have heavy  'natural' periods right from my teenage years, and had the 1st Mirena after a D&C because the situation was getting grim, but I don't recall them being quite so 'nuclear' as the last three!  I have discovered the 'Mooncup' and am finding that a better way to deal with it than tampons/pads. I sincerely hope it doesn't go on for 6 months though!!!  Nightmare!!  I'm supposed to be going on my Silver Wedding cruise in May..hubby would kill me if I spent all my time in the cabin!

I'm a bit concerned the Mirena might be  adversely affecting my mood. Though that hasn't been a problem before am I right in thinking too much progesterone can cause depression?  And this would presumably be made worse as I'm now not adding as much oestrogen as before as I am only on 25mg patches, and because,as you say, its new, so has just  introduced a big dose of the hormone into my system in a short amount of time?
Incidentally, I did question why I was told  the patches had to  be started at the low dose  when I saw a different GP for the Mirena fitting...she said they didn't and gave me a second prescription for more patches so I could double up to 50 mg if I needed  (50mg ones still not being available). I'm not sure what to do about that since its only been 15 days and the GP I am seeing next time is the original one who only gave me a months supply of 25 in the first place. I don't want to put any of the docs in an awkward position, but it would be nice if they were  both singing from  he same hymn sheet!  Dare I ask, what would the general opinion be about upping the dose?

I shall persevere....and make sure I read all those articles before I go back to the GP...forewarned is forarmed.  I am really reluctant to go back on the anti depressants after all the pain of coming off them, and am hoping that these wretched hormones are responsible for those issues rather than having a case of clinical depression.  Unfortunately, when I'm under the 'cloud' the whole concept of having to wait 3 months to see if this works, and then if not another 3 months to try something else etc etc is just more than I can get my head around.  Still. like I said, a better day today...

Thanks once again for all your help and your thoughts.

[Nairn]

Hi wyvern

Sorry to hear you are having such a terrible time.  I don't have much to add to the other responses other than that I have found that progesterone makes me depressed, quite weepy, and I look for the fault in everything - husbands included.   Speak with your GP, but I have tried and given up with coils as they did not suit me and also I wanted something I could control - hated the fact that I could not get the thing out on my own, however they really suit some ladies.   I think you are doing absolutely the right thing to re start the ADs  - but also speak with your GP to see if there might be a better choice for you both in terms of the Mirena and the ADs.  Remember it's your choice as to if you stay with the Mirena.  I was suffering from really heavy periods and once I changed the HRT prep I was on they went away.  The other thing to add is that our mental state ebbs and flows during our life and you should be proud of yourself for taking control and re-starting your ADs, as that is bound to help.  Depression is a health condition just like having a sore arm or leg and the chemical imbalance needs to be treated and tends to be a marathon rather than a sprint.

Given that you have quite a lot going on and a short time to see the GP it might be worth writing down some bullet points before your appointment time and seeing if these can be given to the GP in advance, and perhaps split into 2, HRT and AD medication, that way the GP might have a bit of time to think things through before you arrive and a more focused conversation.  I tend to forget stuff when I walk into the room so writing it down helps.  Also ask for a referral to a meno consultant - every health board has them, they are different from gynaecologists.   Do let us know how you get on

Take care xx

[Perinowpost]

Hi Wyvern

Haven't much time but just wanted to say well done on giving up the AD's, 'that's no mean feat you should be congratulated.  Also, I would definitely up your oestrogen if you're wanting to keep the mirena, as you will be progesterone heavy otherwise and this will help not be helping your mood. If you decide to ditch the mirena there are other options you can try, but at the very least increase your oestrogen x

[EleanorB]

Hi Wyvern,

I am 5 months in to having a mirena coil which I use with a separate evorel oestrogen patch. From my own experience I can tell you that progesterone altered my mood for the worse quite radically, as did not having enough oestrogen. Prior to the mirena I was allowed oestrogen with no progesterone for many months as I have severe  migraine, with the proviso I had my womb scanned regularly. When I developed a polyp the oestrogen only party was over and I had to have progesterone.

Prior to having any hrt at all one of the main reasons I went on hrt was a dreadful depression like nothing I have experienced before, and I have experienced depression briefly in my life. I felt a bit like someone had altered my perception in a way I couldn't describe, there was just the most awful hellish feeling of misery. I also had a terribly short fuse, couldn't cope with any stress which made me feel desperately agitated.  A high enough dose of oestrogen stopped that. I started very low with oestrogen, I think at 25, cutting the patch in half (this was because I had no progesterone to protect my womb at the time) then I went up by increments of a quarter of a patch,  to 50, I think, each time, because the dreadful feeling came back. Within 48 hrs of going up the dreadful feeling would subside.

When I got the mirena I experienced a horrible dip in mood (not as bad as without the progesterone) then the terrible mood came back and I upped my oestrogen again by a quarter of a patch and the truly terrible mood subsided again, leaving me just low and listless. This low, listlessness has got better at 5 months, although I am experiencing brutal insomnia which, if it doesn't let up, may mean I have to have the coil out as it is impacting my health in other ways.

In short, I think if you are sticking with the mirena, you are on way, way too little oestrogen. The progesterone seemed to 'eat' my oestrogen so I had to take the dose up to compensate for it. You are being flooded with a 'feel bad' hormone without enough of the 'feel good' hormone.' I can't speak for the bleeding and oestrogen - others here are more informed than me and so you probably need advice before you up it. I was told to expect some bleeding when it was first inserted, for me this was like an intermittent light period for a few weeks.

It's possible that as you were experiencing anxiety before you became menopausal, that you could get rid of the mirena, stop the oestrogen and treat the depression with therapy and anti depressants and the vaginal atrophy with vaginal oestrogen. It's hard to tell, because your other physical symptoms stopped (night sweats etc)  whether the depression is definitely the lack of oestrogen. My hunch is that it's probably menopause induced, made worse by the fact you had some unresolved issues causing anxiety prior to menopause and the fact you are grieving your mother - I'm sorry for your loss. Whatever way you go I would strongly recommend finding a therapist who can help you through your grief and what is happening now, and to get to the root of what was causing your anxiety for so many years. CBT can be a bit of a sticking plaster and doesn't tend to really get underneath what's going on in my opinion. And I agree with others, I think it would really help if your husband had access to info that helps him understand both depression and menopause, it might make him feel less like you are cutting off from him but rather from everything at the moment. 

I had vaginal atrophy, it's a travesty that GPs are not well informed enough about this. There is a great vaginal atrophy group on facebook run by someone on this board. You can use vaginal oestrogen in the form of pessaries that people on here have already mentioned. It takes a while to build up - unfortunately with menopause there's a lot of waiting for things to get better. You should also use a vaginal moisturiser - have a look at the book called 'Me and My menopausal vagina' which is great and tells you everything you need to know. Patches can help it but a lot of people need oestrogen vaginally as well.

Apologies I have a migraine today so too tired to read this post back. Hope it makes sense. Menopause turned my life upside down, it has done the same to many women. You are not alone. I have felt utterly desperate at times. Things are still rough physically but thankfully, with help, my mood has now levelled out and I no longer feel in a very dark place. You can get there too. Often it's trial and error. 

[Hurdity]

I agree the prog in the Mirena could be causing your low mood and pms symptoms coupled with insufficient oestrogen, I would have no hesitation in saying increase the oestrogen - like I said earlier -  before when you used it you had plenty of oestrogen. However it is the bleeding that is preventing you from doing this. I really would ask if there is a way you can take a short strong course of prog eg Provera in addition ( OK you might feel rough for 2 or 3 weeks but if you knew this was coming and asked your hubs to support you it might work?) - to speed up any shedding of lining.

Personally unless you are really a danger to yourself and cannot cope I would resist restarting the ADs otherwise you may well be putting a sticking plaster over the problem and taking other medication to counteract issues caused by a different medication (the synthetic progestogen) or lack of oestrogen.

You don;t need to wait 3 months before increasing the oestrogen - two or three weeks would usually be sufficient to determine whether that dose was sufficient.

I agree with Nairncat - ask to be referred (to a meno clinic), make that list for the doc, get the bleeding sorted, increase oestrogen, get your husband on your side - tell him you'll be sorted soon! Keep a diary also of what you are taking ( took) and when, what you change, how you feel ....Hopefully on the up from now on - now you have all of us to talk to

Hurdity x

[wyvern]

Thankyou all for your comments.

I'm so pleased (if you get what I mean) that other people have been here and know what I am trying to say.

Eleanor B   - thank you so much for your story, and especially for writing when you felt ill.  I hope you feel better soon.  Your progress with the Mirena seems  chillingly similar to me-  once I had the first patch my mood lifted within a day, only to slam back  about 3 days later. Yesterday I noticed that I felt better which coincided with a new patch...)and no night sweats last night either) I wonder if there is a connection, but regardless I'm sure deep down now that the patch dose is too low. 
I've had 18 months of CBT, which actually finished last week!  It was a bit intermittent - every three weeks here then a gap of 3-4 months there, but I agree with the 'sticking plaster' thought...it works fine when everything is going well, but as soon as life gets a bit rocky or something unexpected comes up, it doesn't stand the test. 

I have decided to up the patches to 50mg...will see how it goes and just deal with the GP if she gets shirty about it  later!   

Hurdity and Nairncat..thanks for your advice. I am going to get a list ready and I have also started a diary to record how I'm feeling and what is going on each day. I am also going to ask the GP for a referral...though I suspect I may be well past the menopause by the time an appointment comes through!!!

Thanks ladies...I'd be climbing the walls still without your support and help.  Grateful hugs to you all

[EleanorB]

Hi wyvern,

Really glad that the messages you're getting are helping. It has been so helpful to me to come on here and see other people going through the same. things.

Just wanted to say i saw my gynaecologist this week for a follow up. She's great. I see her privately and so did a lot of research and found someone very eminent in the field. This has been useful as if I see a GP who is ill informed about menopause they don't question what she advises. Anyway, she said as I am still struggling with some Mirena side effects to up my dose of oestrogen. She mentioned with Evorel some women go as high as 100, I am on Evorel 50 now with an extra quarter patch, so will go to 75. She said it takes a good 3 months to really get the benefits, although like you when it came to low mood, thankfully the effect was much quicker. Obviously I'm no doctor and I'm aware you've had different physical issues to contend with so can't advise you specifically, but just though it would be useful to know.