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[Claire MM]

Hi everyone,

I've got a quite specific problem and wondered if anyone can relate/has advice.

I've been on HRT for 3 years (now 48), I had one ovary removed post giving birth aged 32 and the other one is surrounded by a dermoid cyst. Basically not sure how long my hormones have been low (noone would check!) Prior to HRT I actually had too frequent bleeding (sometimes 14 day cycle) and lots of symptoms from joint pain to itchy skin, night sweats and hot flashes at night which caused early waking and not getting back to sleep. It was a horror show.

Prescribed estrogel and utrogestan cyclically by Newsons as GP was hopeless.

I struggled with taking utrogestan orally - anxiety particularly in the morning, severe itchy boobs, feeling too hot etc etc. Did totally regulate my cycle however.

Eventually tried utrogestan as a pessary, seemed to go OK better tolerated, but I did start to feel pain discomfort and loss of bladder control. I started to struggle with the stopping and starting of progesterone, I was encouraged to increase my estrogen and tried to go continuous with P (wasn't regularly using local estrogen) - after a few months I got a horrible UTI and I don;t react well to antibiotics. Was still painful and felt like hell post antibiotics, felt like UTI didn't go away. I started using vagifem more consistantly, used ovestin a bit externally and changed to Cyclogest and tried to use it cyclically. The local area symptoms seemed to settle down but then I started getting frequent bleeding. I stopped using the vagifem etc I was worried my estrogen may be too high/P too low. In order to stop the bleeding I have taken the cyclogest continuously for 2 months, gradually become more and more fatigued and then this week hit with UTI symptoms, found leukocytes in my urine, tried one antibiotic which caused a bad reaction, tried a single sachet antibiotic. Brought back ovestin and vagifem and have stopped the cyclogest for now. Still having symptoms.

Struggling!

I have been encouraged to get a Mirena fitted at a hysteroscopy this month. There is so much for and against out there on the internet. I seem to have great difficulty with progesterone so I am scared at the idea of having this dose constantly in the area. Systemic P is too hard but I feel that using local P has contributed to the VA and urinary symptoms in a big way. Long story short, does anyone have experience regarding the use of local P either as a pessary or as a Mirena and it's impact on these kind of symptoms? Any thoughts and advice greatly appreciated. I did try using the cyclogest as a suppository but just woke up in a burning hot flash so not sure that's a good sollution. I still feel lousy and flu like since this UTI so not sure if it's still there but looking back I had been feeling very fatigued for several weeks since upping the cyclogest.

I feel like my whole life is falling apart, I'm a single mum of a teenager and I need to be relatively able bodied but I just can't seem to establish hormonal balance and it's knocking me on my arse physcially and emotionally. The Cyclogest pessaries are 200 and I'm on 125 estrdiol (patch and gel combined) and testim gel as my testosterone was found to be zero. My estrogen consistently tests low considering dose in my blood, but I got scared because NHS menopause nurse called me to say they were cutting anyones estrogen back over the RDA and basically blaming too much estrogen for bleeding issues. However i consistently get symptoms of low E (I think!) also despite gel my testosterone levels remain either very low or sometimes zero.

Sorry for my life story! Any thoughts on how to use P and if the Mirena is a good option or not would be great - indeed any thoughts at all, and I do apologise for the essay!!

Thank you

[Hurdity]

Hi ClaireMM

  and please don't apologise - we're here to help

I'm sorry I don't know anything abut dermoid cysts and how that might have affected your hormone production or approach to menopause?

However as someone who has used Cyclogest as pessary and suppository, and utrogestan as pessary I have experience of this.

For the first few years of HRT I used Cyclogest 400mg I was prescribed for 11 days per 28 - I used to out 200 mg up the front and 200 up the back. Yuk is all I can say to that!!! When Utrogestan becae available I switched to that about 12 years ago I think (still taking it cyclically despite my advanced age) and have only ever used it as pessary and yes it affects my bladder and that whole area.

It gives me vivid dreams for a start, so a restless night's sleep, and also wakes me to empty my bladder too (normally I sleep through unless I've had alcohol late). In addition to that I get itchy upper labia just below the mons and Ive no idea if it's fungal but I use canesten on the area and sometimes estriol cream. This usually resolves once I stop the utrogestan.

Re using vagifem - that won't have any impact on the bleeding or oestrogen levels - the dose is tiny and localised so if you have VA issues then best to keep on with it, though some find local oestrogen also an irritant to some extent, though overall improves things. There are other preparations including DHEA and estriol (see the menu on this site).

You could try using the progesterone cyclically again.....

I have no experience or knowledge about the effect of the Mirena on VA and bladder symptons. Perhpas if no-one else responds, start another thread just on that ie Mirena and effect on bladder as there are plenty of women who have one or have had. Re being scared about having the dose constantly - bettwe to have more of it locally than systemically - though there is some systemic absorption with Mirena  especially initially.

Hope this helps

Hurdity x

[Claire MM]

Oh Hurdity, thank you so much for replying! I will do that start another post asking about Mirena and bladder symptoms/VA etc for those who have/have had a coil. I've felt very tired trying to be on the continuous Progesterone, I can't imagine 400 of cyclogest for half the month that must have felt very tiring?! I've also felt this kind of overwhelmed feeling. My reason for going continuous was because I was starting to bleed before I was due to start the progesterone part of cyclogest (around day 10 having had a normal bleed days 1-6!), maybe I could go back to the utrogestan half the month and just use loads of topical estrogen to try to combat these symptoms. Progesterone really is problematic. I don't know if lutigest or crinone gel are any better - have you tried them at any point in this process? I will keep up the vagifem although it does hurt a bit to do but it's good to know it's not causing the bleeding. Yes the weird dreams!!

Dermoids are a bit of a random women's issue, they are basically benign tumours which encase the ovary made up of all different types of embryonic tissue, they found the one I had removed in a CT scan because it contained a tooth! After giving birth that dermoid encasing the ovary twisted and had to be removed as an emergency because the torsion cut off the blood supply and you can die of sepsis quite quickly. Generally they are considered harmless, rarely they can become cancerous. I think that having one less ovary and the other one being encased in a benign tumour has probably led to insufficient hormone levels through my system earlier than someone with both well functioning ovaries but that is just my feeling on the matter. There is very little understanding from medics as to why and how dermoids develop and their potential impact on women, they are considered to be fairly irrelevant. I struggled earlier in my life in regard to hormones also and I feel that I would have benefitted from having my hormones checked at a much younger age than perimenopausal. But this is where we are. I appreciate so much this forum and often read the posts and comments despite not posting myself before. Thank you very much, it can be such a difficult journey and of course everyone is different but it's nice to know I'm not completely alone in it!

Sometimes I think about just having a hysterectomy and being done with it but hopefully it won't come to that. I'm glad to hear your regime is working for you. I recently found out about probiotics which benefit womens 'intimate flora' so I'm taking them also and that might be of some relevance to you, there were two strains tested and found to help and I think sometimes this can benefit the whole area - I will see! Just onto a different antibiotic to try and clear this UTI as the symptoms are still persisting and I feel really weird with it (apparently it's not helpful telling a doctor you feel really weird even if it's true!) Thank you so much for your help :-)

Claire x