How is perimenopause measured if you don’t get your period due to Mirena IUD? I used to get really heavy periods, so I got an IUD right after my second child nine years ago. As a result, I’ve had only two periods in more than 15 years, one before getting pregnant with each kid. Now, at 44, I have all sorts of symptoms — temperature regulation, poor sleep, thinning hair — but can’t test for hormones and don’t know what my periods would be doing naturally. How will my doctor decide if I’m eligible for estrogen?
– Blissfully period-free
One of the best things about progestin-eluting IUDs like Mirena — in addition to the fact that they provide reliable, set-it-and-forget-it contraception — is that many women will not have a period with them. Of course, this also means you may not know what would be happening with your period if you didn’t have an IUD. That is okay!
First of all, you can test to get some sense of where you are in the perimenopausal transition. Progestin-eluting IUDs do not cause a significant change in the progestin levels in the blood. As a result, the pituitary gland and ovaries continue to function the same way they would without an IUD in place — follicle-stimulating hormone (FSH), luteinizing hormone, estrogen, and progesterone all rise and fall as per usual. This means we can check levels of FSH to get a sense of where you are in the perimenopausal transition.
In a perfect world, we like to check FSH on day three of your cycle. In your case, we won’t know when day three is. If we draw blood and your FSH is more than 25 mIU/mL, we are done. Your FSH is consistent with perimenopause. If your FSH is less than 25 mIU/mL, then we may want to try checking again at another time.
Secondly, I would argue all of that testing may be unnecessary. There is no magic point in the perimenopausal transition where estrogen is indicated. If you are symptomatic, it would be reasonable to try estrogen and see if it improves your symptoms.
Your IUD provides the progesterone you need to prevent overgrowth of the uterine lining from estrogen. So you could simply add an estrogen patch or gel. You would want to try it for a few months to see how you feel, but if you don’t have a contraindication to estrogen there is no reason not to give it a try.
Ultimately, in women with progestin-eluting IUDs, testing FSH levels in the blood can help determine where she is in the perimenopausal transition. However, there is no specific point at which estrogen is indicated; just having symptoms is reason enough to try taking estrogen to manage them.
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What’s your advice for women who can’t take estrogen due to stroke risks? Will there be any alternatives coming out?