Types of orthodox hormonal medicines (including the Mirena coil) used to control menopausal symptoms vary from pills, skin patches, skin gels, implants, vaginal preparations and intrauterine coils. Which type you are offered depends on your symptoms, age and health history and fall into two categories - Systemic and Vaginal:
1. Systemic HRT
(circulating in whole body) as a pill, patch, gel or implant with varying doses of oestrogen and if a women has a utereus varying types and timings of progestogen which affects your pattern of periods and protects you from uterine cancer.
Pills -
usually taken daily either oestrogen only or oestrogen + progestogen. Digested in gut, broken down further in liver before circulating body in the blood.
Pros - Dose can be varied and stopped easily. Wide choice of types and doses. Cheap.
Cons - Forget to take. Can cause stomach upsets. May interact with other medicines. Need high hormonal dose as broken down by the liver. May have problems of absorption in women has poor digestion. Lactose intolerance of pills
Patches -
a clear skin patch is stuck to the skin below the waist and normally changed twice weekly delivering oestrogen only or oestrogen + progestogen through the skin direct into the blood stream.
Pros - Easy to apply. Varying doses available and easy to adjust. Lower hormonal dose (as not through liver) and so less side-effects. Continuous release of hormones throughout day rather than all in one single dose.
Cons - Can peel off early and cause skin irritation. Looks unsightly.
Skin Gel -
daily use of a clear gel applied to arms, shoulder, lower abdomen and thighs delivering oestrogen only direct into the blood stream.
Pros - Varying doses available and flexible to adjust. Lower hormonal dose (as not through liver) and so fewer side-effects. Continuous release of hormones throughout day rather than all in one single dose. Good alternative to patch if get skin irritation.
Cons - Expensive. Can feel sticky and should not wash area for an hour after use. Only available in oestrogen only form at present so will need progestogen pill if you still have a womb.
Implants -
small implant inserted under the skin of abdomen or buttock every four to eight months slowly deliverying oestrogen only direct into the blood stream.
Pros - No need to remember to take HRT. Gradual release of hormones at lower doses as taken direct into the blood stream and not broken down by the liver, so fewer side-effects.
Cons - Little flexibility once in place. Difficult to remove and vary dose. Minor surgical procedure and need regular blood tests to monitor blood oestrogen levels. May lead to very high levels of oestrogen in blood.
2. Vaginal HRT.
Oestrogen used in a tablet, pessary, cream or ring inserted into the vagina to help vaginal and bladder problems - oestriol is least carcinogenic form.
Progestogen coil (Mirena) - releasing low doses of progestogen - to suppress normal cyclical womb lining changes.
Vaginal tablets -
usually inserted daily with a 'pencil sized' applicator until symptoms reduce ( a few weeks) then use twice a week. After three months try to stop.
Pros - Easy to insert, not messy, stopped easily, oestrogen works locally, few side-effects.
Cons - Helps vaginal and bladder symptoms only.
Vaginal cream & pessaries -
usually put into vagina daily using an applicator (or finger) until symptoms reduce ( a few weeks) then use twice a week. After three to six months try to stop.
Pros - Easy to use and stop, oestrogen works locally, not absorbed into the bloodstream, few side-effects.
Cons - Can be messy. With the cream may insert too much (especially if using the applicator rather than a finger) so oestrogen enters the bloodstream. Only helps vaginal and bladder symptoms.
Vaginal ring -
inserted into the top of vagina where it slowly releases oestrogen. Ring needs to be replaced every 3 months for a maximum of two years. Directions on how to insert the ring is given in every pack.
Pros - Convenient as only inserted once every 3 months, continuous release of hormones into vaginal tissues.
Cons - Can be awkward to insert, helps only vaginal and bladder symptoms, is felt by some during intercourse (if so remove and reinsert afterwards).
Mirena coil -
a plastic coil inserted by a healthcare professional (into the neck of uterus) which releases continuous small amounts of progestogen. Although primarily used for its contraception it is a popular treatment for heavy periods in peri-menopausal women and can act as the progestogen element of an HRT programme.
Pros - Convenient as only inserted every 4 years if using as HRT, continuous release of hormones to utereus to control build up of blood in utereus lining, can be used in combination with oestrogen HRT.
Cons - Can be painful and result in erractic bleeding after insertion (should settle after few months), may cause reduced libido, weight gain and mood swings. As affects normal period cycle, women don't know where they are in the menopause. Not recommended for women with uterine abnormalities or plevic inflammatory disease.