Mirena coil, pill & hysterectomy - how they impact menopause

Read the full video transcript below

Today's topic

Hello and welcome to my weekly video blog. And today on "A.Vogel Talks Menopause," I'm going to be discussing how going on the Mirena Coil or having the progesterone-only pill can affect you as you start the menopause. And I'm going to talk a little bit, too, about what can happen after a hysterectomy.

Mirena Coil and progesterone-only pills

So let's look first at the Mirena Coil and the progesterone-only pills. I get an awful lot of women contacting me wanting to know if they're going through the menopause. And the problem with this type of contraception is that it very often stops your periods, so you have no idea if you're actually starting going through or have actually been through the menopause. But a lot of women can start to get menopause symptoms at this particular point, and this is usually the first indication for them that something is actually changing.
 
Now, the problem with these types of contraceptions is that they keep your progesterone levels artificially high. Now, once you start the approach to the menopause, your oestrogen levels are going to start to fall, but your progesterone level is going to stay up here, and it's the gap between these two that can actually cause problems.
 
When you're going through the menopause, it's not so much about how much hormone you have of each one, but it's about the relationship between oestrogen and progesterone. So if your progesterone levels are quite high and your oestrogen starts to fall, then you can end up experiencing low oestrogen symptoms. And the main ones will be things like anxiety, flushes, sleep problem, joint aches and pains, stress palpitations, mood swings and irritability. It's usually at this point that the women contact me to ask what they can do to see if they're going through the menopause.
 
This is actually quite difficult because, A, you're not getting any periods to tell you what's actually happening within. But if you go to the doctor and get a test, because your hormone level is being kept high because of the coil or the progesterone-only pill, then it's very difficult to measure your own hormone levels. So at this stage, if you are maybe in your late 40s and early 50s, you're using one of these sorts of contraceptions and you're also starting to get these menopause symptoms, then it's more than likely that this is what is happening.

Options

Now, at this particular point you have several options. Because the longer you go on, the lower your oestrogen is going to get, so it's possible that your low oestrogen symptoms will actually start to increase as time goes by. You can ride it out because at some point, usually after five or six years, the Mirena Coils tend to lose their efficacy and at that point your own hormone levels will actually start to fall in line with oestrogen.
 
The other thing to do would be to maybe discuss with your doctor if you have actually still need this particular form of contraception, or is there anything else you can do that will allow your hormones to actually balance out. Some doctors at this point may actually offer you oestrogen-only HRT to add on to the progesterone in the pill or the coil. Obviously that's something you need to check with your doctor, is it actually okay to take these two together and how long can you take them together before you might actually need to go on to HRT. So this is quite a complicated one because there can be a number of factors going on and the fact that you can't actually see what's physically going on with your periods can be quite confusing.

Hysterectomy

Now, as far as hysterectomies go, again, we get a huge number of women that have maybe had the operation a number of years ago and they're really not sure if they've had the menopause, if they're going to get the menopause, or if they ever will get the menopause.

Different hysterectomies

Now, there are different types of operations. We have the total hysterectomy. Now, this would be where both the womb and ovaries are removed. In this case, unless you are already through the menopause, you will fall very quickly into a full menopause because it's your ovaries that actually oversee a lot of the hormonal work that goes on in the body. So you will find or a lot of women find that very quickly, they can end up with a lot of the usual symptoms such as hot flushes and mood swings and also fatigue.

HRT

Now, in most instances, especially if you're maybe in your 30s or early 40s, as long as it's appropriate, you're very often offered HRT for this. And we know that an awful lot of women don't want to go on HRT, but this is a really difficult situation. Your body has to respond very quickly trying to re-balance without the hormones and it can be very difficult for the body, and what we tend to suggest is to go on a very low level of HRT if you're offered it, just until the body starts to rebalance itself, and then you can come off really slowly. And we would say to people, try to maybe come off in about a year, to do it very slowly. That way you're actually giving your body something that's more like a natural menopause rather than something that's literally happening overnight.

Can I do without HRT?

There are women who say to us, "I don't want to go on HRT. Can I do it without it?" You can, but it can be very difficult and you need to take care of yourself really well. This is something that I would suggest that if you know that you're actually going to have the operation, is to spend maybe six months beforehand, if you know that long in advance, to really get your body in tiptop condition as much as you can. Because the stronger you are, the more robust your immune system is, the most robust your recuperative powers are, then the more likely you are to bounce back a lot quicker.

What else can help?

Acupuncture can be really good at this particular point as well, and I would also recommend something like a good Multivit and extra magnesium and some vitamin Bs as well just to help to support your nervous system because it will be greatly affected by the operation.

Recovery time

The other thing with a total hysterectomy is...and a partial one...is that this is a major operation. And we get so many women who have had the operation and a month later they're like, "I want to get back into the swing of it and I'm really tired, and I can't do this and I can't do that." This has been a tremendous stress on your body not only because of the loss of hormones and your body's having to struggle really hard, but just the fact that you've had a major operation. Your body needs lots of time and lots of TLC to get back into balance, so really, really take good care of yourself at this point.

Uterus removed but ovaries remain

The other main type of hysterectomy you can get would be where you've had the uterus removed but your ovaries remain. In this case, you would normally get the menopause at roughly the same time you would have done had you not had the operation. The only problem here is that you have got no periods to guide you as to what's happening and if you are actually approaching the menopause. So like those ladies on the Mirena Coil and the progesterone-only pill, you really need to go by your age. Are you in the average age group, which is 45 to 55? This is when most women will go through the menopause. And are you getting the usual menopause symptoms such as flushes, sweats, mood swings, irritability, joint pain, etc? If that's the case, then it's more than likely that you are starting the approach to the menopause.
 
You can ask your doctor for a test. They can do a simple blood test to see whether your hormones are changing. The problem is that it's not particularly accurate because the test will depend on your hormone level on the day, and as we all know, your hormones can go up and down like a yo-yo and very often, you can get the test done and it will come back either inconclusive or, "No, you're not going through the menopause," when in fact, you are. So that is just something to bear in mind and, in this case, it really is a question of putting all the little pieces of the jigsaw puzzle together to get the picture that you actually need.

Going through the menopause again?

Now there's just one other little thing here. If you have had a full hysterectomy before you would have started the menopause, we do sometimes get women who are approaching the menopause age and say, "Am I going through the menopause again? I'm getting flushes. I'm getting sweats. I'm feeling really low. What is going on?"
 
Now, there could be two issues here. One is the fact that there may be stress that may just be stress, it could be low iron, low thyroid function, low vitamin D. So if you're in this situation, do get these tests done by your doctor just to rule them out. But the other thing that can happen is that, even though our ovaries were removed, our body can still produce small amounts of oestrogen from other sources, and these other sources also tend to decrease the production of oestrogen as you would approach the normal menopause age.
 
So although, if you've had a total hysterectomy, you can't go on to have a second menopause, you can sometimes get a few menopause-like symptoms at this particular point and you would treat them in exactly the same way as you would normally.

Any questions?

Again, this is really quite a complex subject and I'm just trying to give you a little bit of information maybe to make that picture just a little bit clearer. If any of you have any questions on this, please do get in touch and I'll do my best to help.
 
So I'm looking forward to seeing you next Monday for another "A.Vogel Talks Menopause."

Meet the author

Hello lovely ladies, my name is Eileen and I have worked in the Education Department at A.Vogel for over 18 years, lecturing and advising on many health concerns via the Helpline, including the menopause and its dreaded symptoms.

My own personal experience of going through the menopause (and surviving it), which I regularly blog about, as well as that of hundreds of menopause women who ring the helpline or email me every day, allows me to offer my guidance, advice and sometimes just a much needed shoulder to cry on, to menopausal women all over the world.