Conflicting GP phone line HRT consult?

[SabrinaThwaite]

Last year I had a phone consultation arranged through my GP for menopause symptoms (they outsource this to specialists as a quicker route than GP appointments).

All good, very helpful doctor who prescribed Femoston 2/10 (sequential) for a year with the recommendation to then to switch to a non-sequential HRT. You have a monthly bleed with Femoston but it’s described as a withdrawal bleed in the medicine leaflet.

A year on I’ve had the review with another doctor (obs/gynae) as a phone consultation and I explained the above. She told me that I should stay on the sequential Femoston as I’m still having periods and I should wait until they pretty much stop before switching to non sequential (otherwise I’d be ‘fighting against my body’ ?)

I’m now 58, and was having pretty irregular periods before starting HRT, my main reason was taking it was anxiety (which it certainly seems to have dealt with).

But are they periods or withdrawal bleeds as per the medicine leaflet? In which case they won’t stop if I keep taking sequential HRT?

Do I just need to see a GP face to face to sort this out, assuming our surgery has one that is good for menopause? I didn’t get the feeling that the review doctor knew what she was blethering on about.

I'm on 1/10 femoston. I started at 55 and now 58. I will discuss at next review if should move to gel or a patch. However, apart from persistent brain fog, it seems to suit me well.
At 55 I was still having periods. I likely would not now. I had menopausal symptoms and felt quite desperate.
I do know that the regular bleeds on femoston are withdrawal bleeds rather than periods though.

Thanks @DizzyDandilion - the online doctor didn’t seem to know that it’s a withdrawal bleed, which makes me question her advice. Femoston seems to be suiting me, and the bone density benefits are good, but I’m fed up with monthly bleeds.

It's quite straightforward really but the drs haven't explained it well.

Sequential HRT always gives a withdrawal bleed for as long as it's used (with rare exceptions in some women.) It mimics a natural cycle. So if you stuck with it to age 90 that would happen.

The medical guidance is that for women who are not post-meno (12 months with no natural periods) they use sequential.

For women over 54 they can try using combined continuous as 80% are not having ovulation activity.

The downside of younger women using combined continuous is break through bleeds and then they have to have investigations.

There's been a trend lately to swap women onto continuous after a year on sequential but it often just creates problems if it's done too soon.

It's a choice , however. I've used sequential for years and I have a friend who's 70 still using sequential, out of choice.

So- it's up to you to decide.

@JinglingSpringbells My confusion was the second doctor didn’t seem to think that Femoston gives withdrawal bleeds, and that I should carry on using the sequential until the bleeds stop - but that’s not going to happen, is it? So when do you know when your periods have actually stopped?

I’m 58, so don’t think I fall into the ‘younger woman’ category.

If only these drs would get themselves on an HRT training day!

There are two types of Femoston.
You could swap to the combined continuous type.
https://www.menopausematters.co.uk/postmeno.php

At 58 it's very unlikely you're having natural periods.
There's no way to find out except stopping HRT for at least 12 months to see if you have a period.

Thanks @JinglingSpringbells

I had much more confidence in the first doctor who prescribed the sequential Femoston with a recommendation to switch to the combined continuous after 12 months - she is listed as a menopause specialist, whereas the one yesterday is listed as obs/gynae but not as having an interest in menopause.

I think I’ll go back to my GP to get this straightened out.