Thanks Jingling.
I think my point is, that unless someone has read your post, they don’t know this stuff.
You say the bleeds are an inconvenience nothing more, and refer to ‘if people want’ - suggesting there is a choice to be had about continuous or sequential. But people aren’t told this or told there can be irregular bleeds, but it’s nothing to worry about. They then do worry and wonder if there is ominous significance in it. And they don’t know they can choose. People want to be instructed by their GP as they are taking prescribed items and aren’t confident to choose. This question about bleeding comes up every few days here and on other boards ….but what about all the women who aren’t part of forums and don’t find out the answers? And if asked, GPs offended don’t know. They say ‘it’s sequential to avoid breakthrough bleeding’ but never say if that’s an issue or why, or if there is actually flexibility to choose…..because I think they don’t know themselves and haven’t looked into it enough to give informed answers to the questions they get asked, never mind offering the key information BEFORE women even think of the Q.
Thats the point isn’t it…..lots of the Qs only occur to you after the initial appointment or after you start HRT. What women need is to be provided with all that info uproot to, before they even know these are questions they will wonder about.
- If taking sequential, exactly when should one start, especially if there is no regular natural cycle.
- What different possibilities are there for a bleed arising from this.
- Whats the difference between a naturally occurring bleed and a HRT induced bleed and can you tell the difference?
- Is there any bleeding/lack of bleeding that one should be worried about?
- Does the timing of the bleeding matter or not?
- If one gets irregular spotting, is it a concern?
- When should a move to continuous be considered? Needs to be identified in terms of something women can identify and measure, not something like a year without periods.
- Is it a problem to try and go continuous sooner? What consequences? Do these matter from a medical point of view? Are they dangerous?
- Is continuous vital after a certain age/no periods?
- Can dosages be adjusted? Within what parameters?
- What next? Exact time for a review? Any tests needed?
These are standard questions that occur to women as they start HRT based on very limited info. Most women won’t ask most of them at an initial appointment and be left wondering. Why can’t GPs make sure they know that info in advance and give the info or provide a leaflet or link to a sheet that gives all these Qs and As. Even if you return to the GP with some of these, they don’t really know or can give an answer but not the REASONS why. Given peri menopause is a changing cycle and symptoms and HRT normally doesn’t remain static from the start to end but needs changing to suit the individual and their evolving menopause, it really shouldn’t be a ‘here’s your stuff and some vague and unclear guidance on how to take it today. Goodbye’.
Perhaps HRT is more complex because it’s so individualised in doses and because women go through the shift from peri to menopause differently and at different scales and speeds. GPs usually prescribe the conditions which follow more standard patterns or for shorter periods of time, so maybe HRT is more challenging to prescribe and provide info for.
I certainly think there’s probably too much and too many possibilities to cover it all verbally and for someone to take it all in. That’s why some kind of comprehensive document should be issued - lots won’t read it, it at least if they later have a Q, they can refer to it. Even some of the info sheets on useful websites don’t actually cover all of the key Qs women have or the reasons for the answers.
Perhaps it’s just me that wants to understand more and for whom asking questions and info gathering is just a key part of life!