Advice on changing to conti from sequi please.

[BigButtons]

I am 56. Have been on HRT gel and now everol 100 patch and utrogestan for 5 years( sequi).

I was still having periods when I started, but of course have no idea if and when they have stopped now.
i asked my GP to switch from utrogestan to norithisterone. I am really intolerant to the utro but know that I can tolerate norithisterone much better.
She wanted me to go on a conti regime as she says it offers better endometrial protection after 5 years on sequi.
Of course that strength of pill is not available round here so I am using half a 5mg tablet on a sequi basis until the lower dose pills become available.
tbh I am scared of having to take progesterone everyday. It makes me feel crap and norithisterone is the best of a bad bunch for me.
Is this something we all have to do after 5 years on HRT?
thanks 🙂

Anyone🙂?

Hi OP,

I changed to continuous towards the end of last year. I had been on sequential around 2 years, and had a scan and it was confirmed in menopause no there are no eggs left. I was having a normal period month, which was just a withdrawal bleed. I stayed on the same dose , but now the progesterone side would be constant instead of half the month.

I had to give it some time, but last month I saw the Dr again as I just was not getting on with it the same way. I had constant spotting, awful bloating, weight gain and some mood swings, where before on sequi I didn't. It turns out the progesterone dose was too strong, and now I am on a lower dose of continuous, so both estrogen and progesterone. Three weeks in now and I feel so much better.

I was on the tablet, but now on the patch, so it is just the one combi patch, changed twice a week.

I think it is important to move over to continuous, I am treated by a gynae (I am not in UK), so I trust his knows his stuff. You need the continuous progesterone as otherwise you can get an estrogen build up on your lining of your uterus. It is more than likely you are only having a withdrawal bleed, not a natural bleed. And it lowers the risk of endometrial cancer even more.

I feel it is a bit like starting over again to get the dosage right unfortunately. For me anyway, but others may not find this at all.

I am 53 and he said he would have changed me over to continuous at age 55 anyway. But as I am now confirmed in menopause, it just made sense to change now.

Meant to add, my patch is combi, Estradiol 50ug / norethindrone 140ug.

Much lower dose than estrodial 2mg / norethindrone 1 mg (in tablet form)

She wanted me to go on a conti regime as she says it offers better endometrial protection after 5 years on sequi.

This isn't entirely the whole picture @BigButtons

The statement on using Utrogestan says that it is safe for 5 years (at least) for endometrial protection. This isn't the same as saying it has to be changed or that conti has to be used. It just means the evidence on Utrogestan is only there for the 5 years.

Is this something we all have to do after 5 years on HRT?
No it's not. I've used sequi for around 15 years with a highly respected consultant.

I also have a friend aged 70 who's been using sequi (with Utrogestan) for 17 years (on the NHS.)

You need the continuous progesterone as otherwise you can get an estrogen build up on your lining of your uterus. It is more than likely you are only having a withdrawal bleed, not a natural bleed. And it lowers the risk of endometrial cancer even more.

As long as you have a withdrawal bleed, the womb lining is being shed. No women post-meno have a natural period anyway- they are all withdrawal bleeds.

There is a tiny higher chance of the uterine lining building up with sequi BUT sequi is also safer for breast health.

Not many GPs seem aware of this, but breast specialists say that sequi is safer. This is because the breasts have a 'rest' from the effects of progesterone (and it's the combination of oestrogen+progestogen that can promote BC.)

Depending how long you want to stay on HRT, Utrogestan appears to be safer for breast health.

@JinglingSpringbells thank you. The HRT care round here is pretty poor. They will give it our no issues , but there is never a discussion or follow up and even the female gps who are about my age just refer me back to the BMS. They seem very rigid in their thinking.
i know I can tolerate very high dosage of norithisterone as a few years back- after I had the mirena fitted -I started bleeding more and more and they used shed loads of nori to stop it . Apart from some spots it was ok. I was on about 15mg per day for a while until the coil was removed.
I am sure 2.5mg of norithisterone for 14 days will be ok. She said I needed a higher dose because I was on everol 100. Again all she does she show me chuckle from the BMS.