Why sequential?

[NotThatHomer]

I'm struggling with the sequential type of HRT. I was prescribed Evorel Sequi, for several issues, but mainly joint pain. I'm on the third month, joints are far better in the days that I'm taking progestogen, and sleep far better on those days too.

I'm 52 still having periods, so that apparently means sequential HRT for a year. But why? If I had a Mirena, I'd have progestogen for the whole month. So what's to stop me having continuous HRT now?

Because you'll most likely have very irregular bleeding if you take continuous combined.
With sequential when you stop the progesterone part it induces a bleed at regular intervals. With continuous combined the you can bleed irregularly if you are younger or still having periods or being within a year of your last period.

The mirena works differently as it gets absorbed into the lining of the uterus direct and doesn't let it build up so you don't get the irregular bleeding.
Mirena plus Oestrogen is a good combination.

I've had irregular periods all my life. I've only bled once on the HRT (at the beginning of the progestogen phase) and now on my third pack.

So there would be no harm in asking to try continuous? Apart from the possible inconvenience of an irregular bleed. I don't want a Mirena.

It might not be an irregular bleed@NotThatHomer but more like spotting all the time. The lining has to be made permanently thin with the progestin and this is harder with oral types than with the Mirena.

It's actually quite unusual to feel good on the progestin phase. It's Norethisterone in that patch, isn't it?

@JinglingHellsBells

Yes, it is Norethisterone. Ironically I put off taking HRT because I was worried about feeling rubbish on the progesterone! I have Googled and low progesterone levels can linked to joint pain, also it can help you sleep. I did have some breast tenderness with it at first, but that has settled.
I don't understand what is expected to be different after a year on Sequi? Why is a year the point at which you can change to continuous?

Anyway, I still have just short of 2mths left of patches, I'll use those and see how things are by then. I'm just looking at my options.

I wasn't aware of the rule of a year on sequi :)

The only rule that's out there is change to continuous a year after a final period. That's the definition of menopause.

Also, the progestin Norethisterone is not actually 'progesterone' - it's man-made synthetic type (also used to delay periods if women need that!) So the calming effect and joint-relief doesn't apply to it as it's not the same thing.

Patient.info states "Women can be prescribed continuous combined HRT if they have received sequential combined HRT for at least one year; or it has been at least one year since their last menstrual period."

Which was part of the handout that the GP gave me.

@NotThatHomer That's unusual :) Obviously only women hwho have that brand can read that.

This is from Menopause Matters and written by Dr Currie who was awarded an MBE for her meno work last year.

www.menopausematters.co.uk/postmeno.php

Period free" or continuous combined therapy can be used by women who are 54 + yrs, or more than one year since last period at any age. The criteria should be fulfilled in order to offer such treatment to women who no longer have a continuing ovarian cycle, so that steady levels of both estrogen and progestogen can be achieved. When there are steady levels of estrogen and progestogen from daily administration of both, the womb lining stays thin. Although some bleeding in the first 6 months of therapy is common, there should not be bleeding after that and the lining does not go through the stages of stimulation and then shedding as it does during a normal cycle and with sequential therapy

No, the quote was from the website www.patient.info - which our GP uses (in fact most of the GP surgeries we've been with seem to use it), not the medication leaflet. Although the GP printed it off for me.

patient.info/womens-health/menopause/hormone-replacement-therapy-hrt

Yes, I know that website well (won't out myself but you might understand what I mean!)

I'd rather go by what a consultant gynae says as linked to above.