GP changed my HRT from Evorel Sequi to Evorel Conti - is this incorrect?

[PeacockHat]

I was prescribed Evorel Sequi patches 13 months ago for symptoms of peri menopause, and it has worked really well. I still have a period each month.

Following a recent medication review with a GP, I was advised that Evorel Conti would be better for me and possibly stop my periods altogether.

I received the Evorel Conti patches, but there was no patient information leaflet in the box. I've had a look online, and it seems that Evorel Conti is for women who haven't had a period for over a year. Is this correct, and should I be staying on the Sequi patches? The more I'm googling, the more confused I'm getting! Thank you.

I had the Conti for about nine months (having a period every month) and was then told I was on the wrong one as I was still menstruating and they changed me to the Sequi. It's very confusing. Incidentally, I felt great on the Conti and awful on the Sequi so ended up coming off completely.

I'm in perimenopause but using Evorel Conti. It was suggested for me because I am on the Cerelle mini pill, which stops my periods completely (even though I think I'd still be having them if I wasn't on the pill). The specialist nurse explained that Evorel Sequi would artificially bring my periods back (as a withdrawal bleed), and essentially said "why have periods if you don't need to"! There's no danger in taking Evorel Conti before you're in full menopause and I don't know why the information leaflet doesn't reflect this.

I actually had a thread about this a while ago, in case it's useful! I found the answers reassuring

Thank you both! That's reassuring.

That's such a useful thread, thank you. No idea why it didn't come up when I searched though!

No it's not right and you may end up with your own periods breaking through.

It may be suitable for women in their early 50s who have few periods- such as 2 a year but haven't gone 12 months with none.

Menopause Matters website is a doctor-led site and gives info on this.

https://www.menopausematters.co.uk/postmeno.php

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.

@ElliePascoe There is not 'danger' but the nurse is wrong.

The risk is that women will have irregular bleeding as the amount of progestogen isn't always enough to override their own estrogen + cycle (in peri.)

It can take 6 months for any women on conti HRT to settle into a no-bleed pattern.

Spotting is very common for 6 months.

With women who are no post-menopause, the bleeds can carry on because they are not ready yet for conti.

This gives doctors a problem because any bleeding on conti after the first 6 months has to be investigated. So it puts women through the stress of perhaps a biopsy or a hysteroscopy (usually unnecessarily but drs follow the protocol.)

My GP said guidelines are switching to Conti after a year of sequi. You don't have to though, especially if you're younger than average age of menopause.

Thanks for posting. I have been on sequi for 5 years so gp has suggested switching to conti. I’m early 50s and get a bleed every 2 months or so (might be breakthrough/normal period or fibroid who knows).

Sounds like it might be too soon to switch?

That's a newer guidance , I think, from Dr Louise Newson who wrote GP guidance.

The former guidance by Dr Currie (consultant gynae) still stands for obvious reasons.

Yes, you can switch after a year, but there is no logic to it if someone is a long way from the age of average menopause (51) and it goes with the risk of breakthrough bleeds that will either mean changing back to sequential or investigations.

One thing that GPs don't seem to know is that conti HRT has a higher risk of breast cancer and breast specialists prefer women to use sequential.

This is what my GP said.
By the way, I'm almost 50.

Yes, but as I said in my post I don't have periods at all (and haven't for several years) because I'm taking the Cerelle mini pill. After the first six months of taking it, my periods disappeared completely and have never come back. Being on Evorel Conti hasn't changed that at all. The reasoning was that, because I didn't have periods before I started on patches, it would be silly to switch to a patch that might give me periods again. Obviously, this would be different for somebody whose natural cycle wasn't already being suppressed by their contraception.

I'm nearly 47, btw, so almost certainly several away from menopause.

I'm 46, peri menopausal and still having regular periods. I was put on Conti rather than Sequi to try to slow down my bleeding. Hasn't really worked but I feel much better.