GP says Continuous HRT from day 1?

[NellyCat]

I had a GP appointment today re: HRT. She said that the guidelines have been changed and they now tell GPs to put people on Continuous HRT from day 1. Has anyone ealse heard that? I am just 51 and last period was early September, Was having regular periods up til then but every 6/7 weeks.

Confused now what to do with my utrogestan. What are the pros and cons?

Bump, anyone else heard of going straight to continuous HRTbi.e taking progesterone every day?

Not heard anything about guidance changing.

Sounds like she is mixed up.

Sequential HRT is for women who have not had a period for 12 months.

You should be on that. 12 days of utrogestan each calendar month.

I'd go back and ask her and ask her to show you the link/ print out of the info if it's changed.

sorry- brain dead today! Continuous is for women who've not had aperiod for 12 months.

I meant to say sequential is for women like you.

My gp said that too even though i was still having regular periods. I just did sequential anyway.

Yeah I think I will too. She didn't seem to offer any rationale for going on continuous from day 1 and kept going on about when you're 53/54 might as well as you're already past the menopause even though I've literally just turned 51.

I have been on oestrogen gel and progesterone tablets every day for 4 months now. I'm 48 and perimenopausal. I still have the occasional period, just very unpredictable.

That's exactly the reason why you ought to be on sequential!

Continuous combined hrt is for women post menopause or you get irregular bleeding. For women post menopause, there is no bleeding as the estrogen + progesterone in the HRT is balanced = no bleeding.

With sequential you get a withdrawal bleed each month at a (usually) predictable time.

Why don't you query it with your dr?

I have not had a period since January - started hrt in Sept. I take utrogestan every day - not been told to take only so many days a month.

The doc who put me on HRT (push doctor, online, in place of my own GP but seemed just as if not more knowledgeable) said the same to me. I didn’t actually question it, I was just desperate to feel normal again. I have been on continuous since January. But I hadn’t gone into proper menopause because had had periods in the preceding 12 months, one or two. I came on here to see what people think as recently, in the last 3 months, I have had almost normal style periods. V confusing, though I have been stressed out of my mind with other things. No idea how this really works! I take my HRT v regularly now, so shouldn’t my body be fooled into a nice regular state..? Or not if my natural hormones are partying again?

Sorry no help but a similar issue. I have been on sequential for about 10 months (having quite regular periods until then) but when I went to request a repeat prescription recently the GP switched me to continuous. I queried, via the prescription request form, and she said that it’s normal practice to switch everyone to continuous after a year. I understand from other reading that they don’t regard the monthly bleed on sequential as a period, because it’s due to the break in progesterone or whatever, but then how am I supposed to know if I am still having periods? And if I am then like you I thought I should stay on sequential. I now can’t get any further info from the GP. I’m 50.

Just for reference for everyone on this thread.

This is from Menopause Matters (info provided by Dr Currie)en.wikipedia.org/wiki/Heather_Currie

www.menopausematters.co.uk/perimeno.php

www.menopausematters.co.uk/postmeno.php#why

POST MENOPAUSAL -
Continuous combined therapies.

"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.

Start with low dose preparations and increase as necessary for symptom control.

The products marked * are licensed for osteoporosis treatment/prevention.
See below: WHY AND WHEN TO OFFER CONTINUOUS COMBINED THERAPY.

I was told the same, dosage same everyday I'm only a week in so far but I'm on pop pill so makes sense. It's stops the fluctuations

Yes but it may not control the bleeding if your periods haven't stopped- see the link just in case you need to discuss it with your dr.

I spoke to my surgery today regarding starting HRT, which they agreed to.

After all the questions etc, she has put together a plan of continuous HRT, a pill and a gel from day one. I did question this, as I still get regular periods and assumed I would go on sequential. She said due to my age (53) I should go on continuous straight away but expect some breakthrough bleeding. She said if i had been 3 months younger, she wouldn't have done so 😕

I admit, I don't know very much and have only recently started looking into the whole HRT minefield but it seems to go against what I have learnt.

Maybe the guidelines have changed. It's so confusing and I'm bad enough as it is!

Mine did the same but I ignored it and did cyclical anyway, at my next review the next gp said the first gp was wrong.

How do you do cyclical? is it taking the progesterone just for the 2nd part of the month? Sorry, I'm clueless!

For everyone here...!

The guidance is not out of date because women's bodies haven't changed. :)
If you start continuous too early, you may get your own periods breaking through. That's because you have your own estrogen thickening the lining as well as the HRT estrogen.

However moving to continuous is a choice (although GPs won't tell you that because they 'go by the book' rather than individualising treatments, which consultants are able to do as they are more experienced.)

I am 14 years post meno and still on sequential and I know other women (in their 60s) doing this as well. This is because I /we don't feel great on daily progesterone.

Also- depending how long you want to stay on HRT, (maybe more than 5 years) sequential has a lower risk of breast cancer. This is in all the research papers but not many GPs will tell you (or maybe know.)

Using continuous is really a lifestyle choice to avoid a withdrawal bleed.
If your own periods break through, you may as well use sequential for a while longer, or for whenever you want to swap.