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[SB]

Hi, I’m new to the forum and looking for some advice please. I am 53, peri symptoms started around early 40’s which I lived with until starting hrt around a year and a half ago. I started with evorel 25 and have the mirena. Evorel has recently increased to 50. My nurse practitioner has told me that I now need to add progesterone as I have had my mirena for four years and no longer effective for hrt use and has prescribed me utrogestan (saying the mirena can be left in as it is for now, I can’t have a new one just for hrt)I’m really worried about changing things, I don’t cope great with things at the moment, and as I’m already having ongoing issues with indigestion/stomach/nausea which I’m currently trying to sort out with gp, the side effects are putting me off starting it. I’ve voiced my reluctance and nurse has given me a little time to decide what to do as said I could try a combi patch if I really don’t want tablets, which im presuming will be evorel conti. So im trying to read about different types and am getting more confused and worried. Hence why it took me years to finally start hrt in the first place, anxiety and fear are my downfall!!! So advice im after relates to- combi patch or tablet. Which is safer, less side effects. The utrogestan seems to be preferable as more natural progesterone and norethisterone less so as synthetic if I read that correctly? I’m also concerned about taking tablet as not regular mealtimes/bedtimes due to being a carer half the week and says take before bed on empty stomach and I can’t be sleepy those nights if that makes sense. I understand it can be taken vaginilly? Would that be a better option? Or is the evorel combi the way to go? So many questions and never enough time when speaking to nurse as they don’t have the time and need to get the calls pushed through so I feel like nuisance! Any thoughts or advice gratefully received  xxx

[Dotty]

Hi the Mirena is licensed for hrt for five years, so yours will be ok for another year.

Have a look at this document:

https://www.newsonhealth.co.uk/wp-content/uploads/2022/06/The-Mirena-Coil-or-IUS-v21-02.pdf

Why can’t you have a Mirena just for hrt ? If you’ve been told that then it’s incorrect information.

[sheila99]

Dotty has said it all. Other people can get a mirena just for hrt.

[Taz2]

Hi SB. Dotty and sheila99 are correct. This is the advice taken from the menu at the top of the page https://www.menopausematters.co.uk/progestogens.php

Taz x   

[SB]

Hi all
Thank you for replies so far x
She told me mirena is licensed (in Uk) for five years contraception and four years hrt so she wants me to start utrogestsn or alternative very soon as already a bit over the four years. Is she wrong? My doctors do not fit them, it is done at what used to be the family planning clinic for the area and when I phoned them they said they will not fit them for gynae reasons just birth control, I would have to be referred to hospital gynae which is something she doesn’t seem to want or be able to do then by the sound of it? I would love to just be able to continue as I have been 

[Dotty]

Hi yes that’s wrong…it’s 4 years for contraception and 5 for hrt.

Tell the clinic that you need the Mirena for contraception purposes. x

[SB]

 Thanks Dotty, that’s totally opposite to what I’ve been told, that’s a bit worrying! I will phone clinic and ask again

[Dotty]

Look at the documents that have been hi lighted in the above posts.

[Dotty]

Apologies I might have given you wrong info. The info on this website says the following…. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years. However national guidelines recommend that it can be used for up to 5 years for the progestogen part of HRT.

[SB]

No worries Dotty, That makes me feel a little better as that’s how I read that report and thought I’ve completely misunderstood and got confused now
I’m sure that’s why the clinic told me they won’t do it as it’s still ok for contraception until the end of the year. So unless my nurse will refer me to hospital which she didn’t seem to think was an option, I have to decide between the utrogestan in whichever form or a combi patch 

[Dotty]

Hi the info is saying that it can be used for hrt for 5 years.

Look at the link I posted from Dr Newson. X

[SB]

Thanks, I will read that document to her and see what she says, although she seemed insistent it was only recommended for four years and it would be a risk waiting the five years but I don’t know where she is taking that recommendation from? And ask again why I can’t have another one fitted just for hrt

[Dotty]

From other posts on the matter I think family planning / sexual health clinics say they’ll only fit it for contraception. So you just need to tell them that you need it for contraception 🙂.

[SB]

Hi Dotty. Unfortunately the clinic here will not change it at this time for contraception as not due until end of year and then saying I shouldn’t need another one I need to go back to my nurse, armed a little more with info from here, and hope she agrees safe to use for another few months which will give me a  little time to do a bit more research. I’ve realised how uninformed I am! Because I felt like utter rubbish at the start of this I’ve just kind of gone along with whatever I’ve been offered, head in the sand. Couldn’t cope with more than that. There is such a lot I need to know and be more proactive to make sure I get the best option for myself, I’m feeling a bit more positive this morning that I can face it head on  x

[Kathleen]

Hello SB and welcome to the forum.

I seems that your nurse is pushing Utrogestan because the surgery won't fit the Mirena coil. If so this is a disservice to women who use the coil for HRT. I wonder if there has been a change at the surgery and the one person qualified to do the job has now left?

 As the Family Planning Clinics only replace after five years this means that all patients who rely on the Mirena for HRT will be forced to abandon it.

Obviously none of this helps you at the moment but I wonder if it is worth questioning the Practice Manager about it. Surely it can't be right that a routine and effective treatment has basically been withdrawn because the surgery are not equipped to provide it?

I may have got this all wrong and apologies for going off on a tangent but if you complain the surgery may be prompted to find a solution for you. Worth a shot possibly?

In the meantime I am sorry that you are having this trouble, it must be distressing to have a well tolerated regime changed for no good reason and you have my sympathy.

Wishing you well and keep us updated.

K.