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[MillieMoo10]

Hi Lades
I'm looking into HRT and what might best suit me. Initially I thought Utrogestan would be the best progesterone to take but I am now thinking maybe the Mirena Coil would be better, but Ive read on here some people having gotten them stuck inside and I just wondered how this happens? I"m also wondering how insertion would be now that I'm in my late fifties and not very comfortable down there and also about having it taken in and out every 5 years whilst getting older    Do you think Utrogestan would be better if I can tolerate it ?
Any advice much appreciated
Thanks x

[Ermin2trude]

I’m one of the few (and we are a teeny tiny few) that had a problem with my Mirena being ‘stuck’. I have large fibroids and a bulky uterus which couldn’t really accommodate a Mirena, so it nestled itself behind a fibroid with its strings. I had it removed privately in the end. If you don’t have the above issues, then I doubt you will have any problems. My sister swears by her Mirena, I think she’s on her 4th. So many women love them. As for insertion…..well I’m a woman of indeterminate age, and it was fine. Not pleasant but not awful either. I think I found it more intrusive than painful.

[Tinkerbell]

I had my first Mirena fitted when I was 53 and one year post meno. No problems with fitting although a bit of a struggle getting it out when I had my second one last year as the strings had curled up. But again was not painful and I have had worse smear tests.

I use Vagifem as well as systemic HRT. If you decide to go with Mirena may be worth starting on some topical estrogen a few weeks prior to the fitting.

I plan to get another Mirena when this one needs replacing as I could not tolerate Utrogestan. I can't use combination HRT patches either as adhesive causes skin irritation.

[Hurdity]

Hi MillieMoo10 -  Re utrogestan vs Mirena coil - it is entirely a matter of personal preference and nothing to do with age. A couple of times when I have been referred for bleeding or thickened lining the consultant at the hospital has asked if I want a Mirena - and both times ( once 10 years ago, once last year)  I politely declined.

In my case, apart from the occasional norethisterone cycle (probably about 3 times over past 14 years), and an initial 3 months foray with Evorel sequi, all my HRT since 2007 has been bioidentical  and nil by mouth. Mirena would fit the latter but not the former. Menopause gynaes like it because it is very effective in protecting the womb but if you want to use natural progesterone then it won't provide that.

Some women don't tolerate artificial progestogens and undoubtedly the ideal would be for all of us to use bio-identical progesterone such as utrogestan, but the reality is, due to its biochemistry and our own biochemistry, it has to be taken in large doses to ensure that sufficient gets to the womb to protect it, and this is the sticking pont for many of us who don't get on with the side effects from these large doses, even though we are OK with our own progesterone produced during the natural menstrual cycle.

Changing a Mirena every 5 years is no big deal - provided as Tinkerbell says you use local oestrogen too and keep yourself well plumped up in the vaginal regions. If it was every 3 months it would be a different matter!

Presumably at late 50s you are post-menopause but have you been taking any other HRT at all and if not, how long since last period?

Hurdity x

[MillieMoo10]

Thank you both for very useful replies, I think you have eliminated my fear of insertion/removal and the idea to have topical oestrogen prior to removal/fitting is excellent - if I'm honest the way things are going I'll probably been on that anyway in 5 years time !

[MillieMoo10]

Hi Hurdity
That's very interesting information - thanks
I'm 57 and it's only been 8 months since last period and not been on any HRT so far.  I had a lot of unpleasant symptoms during the peri phase but 3 reasons I've not went for HRT yet is 1. FEAR 2. I'm pretty overweight and wanted to lose some before going to the GP (I've lost a stone so far but got another one to go before I reach a weight where the Doc doesn't make an issue of it) 3. I felt it was best to wait until my hormones settled before starting HRT as I was thinking, how do you balance HRT when your hormones are up and down all the time.  So once I've lost that stone I think I'll be going for it and in the meantime just trying to research as much as I can x

[MillieMoo10]

Hurdity can I ask why you didnt want the coil and also what you use for Progesterone ? x

[Cocobra]

Dear All,

Hurdity, as always, has been exhaustive in her precious information, but I can give you my take. I was on Elleste Solo and Utrogestan for the first few years of HRT (having had early menopause), then was moved to Evorel Sequi, and this past month to Mirena and Oestrogel. Perhaps too soon to give you full insight into the latter, but so far so good; some women have found it not easy to tolerate it but then perhaps it's a general problem with tolerating progesterone in different versions. I have not had a problem with it.
As for insertion, I was on local anestesia as the surgeon had to remove a polyp at the same time, so I cannot say how difficult or easy. I was suggested to have the coil inserted years ago, when I switched to the Evorel Sequi patches, but I didn't go down that route because I hated the idea of having something inside me. However, I did switch eventually because I had too much monthly bleeding (and I have a condition that makes me anemic).

[MillieMoo10]

Thanks Cocobra for your valuable input 

[Hurdity]

Hi again MillieMoo - well it depends how much overweight you are re the doc but weight should be no barrier to starting HRT though undoubtedly menopausal symptoms can be more severe if you are overweight - and of course as you approach 60 as I expect you know you will be helping yourself healthwise to lose some extra weight.

Very well done for losing a stone though! It's much harder approaching and after menopause!! It depends how quickly you feel you can lose it, in terms of waiting to start HRT. To me you are at the ideal stage HRT - if you've gone 8 months since last period then you may be not far off menopause especially given your age, and so hopefully your hormones won't be up and down very much but your body hasn't been so long without oestrogen to need to acclimatise.

So I would say sooner rather than later - if you have symptoms that are affecting your quality of life. Don't be scared!

The other thing about the Mirena is that once you are settled you are unlikely to bleed whereas with the other HRT types you will get a monthly withdrawal bleed.

Also as Cocobra said re polyp - do you know whether you have any fibroids or polyps - which might affect bleeding? Not that most women get checked out for these before starting but just thinking about your later than average menopause.

Personally I would swear by patches - and I started HRT at similar stage to you - but slightly younger at 54, and only 5 months since previous period though had gone a few months since the one before that so I was very late peri. It has worked so well that I am still on it at 70! We all have our own preferences though!

Hurdity x

[MillieMoo10]

Hi Hurdity thanks for you words of encouragement x  The weight thing really bothers me ! Im really stuggling to shift it despite a low carb diet and exercising 3 times a week, if I can lose another stone then I will be at the top end of a healthy weight for my height.  Would HRT help with that ? I mean will it speed up my metabolism ?
As far as I know I don't have fibroids/polyps but had no tests so I guess no idea ?
I really think HRT will help my many symptoms but I think I just keep making excuses not to do something about it because of the fear of breast cancer(no family history as far as Im aware) I mean I thought I decided which GP I would book my appointment with (He's male in his fifties and knows me the best) but now Im wondering if I should book one of the female GPs but they are young and nowhere near the menopause themselves.  I previously saw (about 2 years ago) one of the lady doctors for psoriasis of the vulva (never had psorsoris/eczema in my life) and I suggested it was maybe due to peri-menopause but she poo pooed that idea so I'm not sure how much understanding she has of declining hormones as Im convinced that is the reason I developed it (its now in my ears aswell!) 
Im also scared of the ups and downs (emotionally) that seem to be experienced in the months of getting the balance right(and maybe longer), I recently came off antidepressants and that was horrific (I had been on them for 9 years) and don't want to deal with anything that causes upset to my fragile brain!
Im pleased you are still happy to be on HRT at 70 because it does seem to be needed life long -  I just need to put my big pants on and do it ! x