Moving to Continuous HRT after Sequential - what to expect?

[OnlyTeaForMe]

Am 51.
Was post menopausal when I started taking Elleste Duet 1 mg over 2 years ago. It's made a HUGE difference to all my symptoms and I seem to tolerate it well. But I'm not sure why I was prescribed sequential HRT when I was post-menopausal?

My mum died from breast cancer (age 74) so I want to minimise my risk as much as possible and think I now ought to switch to continuous combined therapy via a transdermal patch.

What would be the obvious choice for me to move to next?
Evorel Conti seems to have the same active ingredients (estradiol and norethisterone) so does that seem a logical choice if I seem to tolerating those in pill form?

Anyone made that switch successfully?

[PollyPerky]

If you really want to reduce the cancer risk then you should keep off the Norethisterone and swap to Utrogestan which, according to some research, is neutral re. breast cancer.

So that would be 100mgs daily every day with an estrogen only patch or estrogen gel.

It's pretty much agreed that it is synthetic progestogens that cause cancer with combined HRT.

[PollyPerky]

ps- a continuous sort is not safer. The BC risk is linked to how often and how much progestogen is used so doing a sequi regime reduces the use. There is also no difference in risk for BC between pills and patches. It's the hormones in them that counts.

[OnlyTeaForMe]

Thanks Polly - do you have any links to peer-reviewed research which shows that Utrogestan may have a neutral effect?
I've been looking into this, but only found one study which looked a bit unreliable.
I'm keen on the transdermal route for other reasons - slight decreased risk of clotting, and also avoiding the digestive route (which I think may be giving me occasional problems).

[OnlyTeaForMe]

Do you take the Utrogestan EVERY day? I'm now a bit confused, as although the Menopause Matters mentions Utrogestan for continuous combined therapy it suggests you should take it daily for days 1-25, but then have a break of 3 days?

[PollyPerky]

Yes, there is a link. I posted it yesterday on another topic. It's the International Menopause Society report on women/ mid life health/ hrt.

www.imsociety.org/manage/images/pdf/4429e3dd302aac259ad68c3be7f60599.pdf

Here (Page 126 - though the report doesn't start at page 1 for some reason.)
**
Three studies suggest that micronized progesterone
or dydrogesterone could be associated with a lower risk
than synthetic progestogen. A large European observational
study suggested that micronized progesterone or
dydrogesterone used in association with oral or percutaneous
estradiol may be associated with a better risk
profile for breast cancer than synthetic progestogens6
.
A case–control study from France also showed a
lower level of risk with progesterone than synthetic
progestogens. A registry study from Finland
reported no increase in risk with dydrogesterone after at
least 5 years of use compared to synthetic progestogens,
which were associated with a small increase in risk.
Currently available data imply no difference in risk
between oral and transdermal routes of estradiol
administration.
However, there are not enough
data from adequately powered clinical studies to fully
evaluate possible differences in the incidence of breast
cancer using different types, doses and routes of
estrogen, type of progestogens and androgen
administration.


Also this French study www.ncbi.nlm.nih.gov/pmc/articles/PMC2211383/

We found that the risk of invasive breast cancer was significantly lower with estrogen–progestagen HRTs containing progesterone or dydrogesterone than with HRTs containing other progestagens. The latter group involved a variety of progestins whose associations with breast cancer risk did not differ significantly from one another.
**
BMS report //file:///C:/Users/User/Downloads/menopause_int-2013-panay-59-68%20(2).pdf
^In a large observational cohort study of French teachers,
after five years of use estrogen–progesterone
combination, HRT was found to be associated with a
significantly lower relative risk (neutral for ‘ever use’
of HRT) than for other types of combined HRT
(RR 1.7–2.0)^.

journals.sagepub.com/doi/pdf/10.1177/2053369116680501 scroll thru report to page 169 for info on cancer.

***
You can take Utro for 25 days. The idea is that with a 3 day break you may get a very slight bleed if there is anything to come away. But all other conti where there are 2 hormones in a tablet, has the 2 hormones daily.

[OnlyTeaForMe]

Thanks Polly - I'll have a read now.

So I've had a GP appt this afternoon and come away with a prescription for:
Estradot 2 x wkly M 25 mcg estradiol / 24hrs (Patch)
UTROGESTAN Micronised progesterone 100mg at bedtime from day 1 to 25 of each 28 day cycle

Is that the sort of combination you were suggesting?
To be honest, the GP pretty much asked me what I wanted and then looked it up . At first she thought the Utro was only a vaginal capsule until it out on my menopause matters print out.

Doesn't instil me with a huge amount of confidence...

100mg of Utrogestan sounds like a lot though (compared to the Norethisterone 1mg in my Elleste duet)? Is it suspended in an oil or something?

[PollyPerky]

Yes that's right. Or you can do 10 days x 200mgs and that will give you a bleed once you have taken the 10th capsule .

The 'French way' is to use it vaginally and you can do this too. There used to be a 200mgs version but they have discontinued it now in UK (though might be available for fertility treatment.)

Yes the progesterone is in oil- think it's soya or peanut. Make sure you aren't allergic.

It's totally different to Norethisterone in terms of dose.

[OnlyTeaForMe]

Thanks again!

Have you tried both the 200mg for 10 days and the 100mgs for 25 route?
With my current regime (Elleste Duet) I have 16 days of estrogen then 12 of progesterone and I tend to feel fine for the first 3 weeks, but then a bit PMT-ish for the last week of the progesterone phase.

I'm wondering if taking progesterone almost every day is going to 'dull' my estrogen 'high' or whether I won't notice?

[PollyPerky]

I do the 10 days x 200mgs every 6th-8th week. This is with supervision from a consultant so I can access scans to check it's working.

I have tried 100mgs daily (my 'dose' was 21 days then a week off ) and got a migraine each day (due to the level of Utro falling on that dose) and spotting. I gave up after a month on that and went back to the 10 days.

I'm wondering if taking progesterone almost every day is going to 'dull' my estrogen 'high' or whether I won't notice?

suck it and see :) You may be fine. Everyone reacts differently. Some women feel terrible on it, others feel fine.