What is sequential hrt for?

[jackdawdawn]

Hi. Just having a conversation with my doctor about HRT today. I am really confused about the difference between continuous and sequential hrt, and the answers he gave weren't enlightening.

So does anyone know why CC HRT is given to post meno women, and Sequential to perimenopausal? ie are there medical grounds for having a bleed (or is it like the Pill, just to give the impression of a cycle?) He seemed to think it is okay for a peri woman to have CC HRT. Does it cause side effects in anyone's experience?

Or perhaps he's right. Has the guidance changed? Are they trying to phase out Sequi or something? Grateful for any replies!

@jackdawdawn The guidance has not changed and they are not phasing out sequi.

There is no need to ever change from sequi. It's there because most women not having natural periods any more, prefer a no-bleed type.

The reason women in peri can't / don't use continuous is because it doesn't always control their natural cycle- so they get a breakthrough bleed at some point anyway, maybe every few weeks or months.

Using sequential usually (but not always) creates a cycle which overrides a natural cycle, so you get a predictable monthly bleed. This is an artificial one like a break in the Pill, BUT if your own hormones are still circulating you will have some of them too (but the hrt should set a pattern.)

There is research around (in the small print about hrt) showing that continuous HRT has a higher risk of breast cancer . It's not a huge difference- about 1 - 1.5% per woman - but it's enough for me personally not to want to use it and am many years post-meno.

Thank you JHB. Yes, I had read that about the elevated cancer risk too - something about a higher dose of progesterone (daily) in the combined type.

I can see why unpredictable bleeding would be a complete nuisance to women & how a monthly 'period' type experience would be more manageable.