Pharmacist prescribing sequential HRT after a year on continuous?

[thaneofglamour]

I'll try to cut a long story short. I have been on HRT for about 4 years, first on Elleste Duet ( I had bad ovary pains with this, possibly or possibly not related). I was swapped to Evorel Sequi, then had a hiatus and then Estradot , followed by Estraderm either Utrogestan. All the time on these I have had bleeds but hard to tell if natural after all this swapping about. I have proven allergic to all transdermal HRT.

After a failed attempt with Lenzetto the pharmacist has suggested Femoston 1/10. This is sequential, so liable to lead to monthly bleeds with the ovarian pain associated with this. Why on earth would she suggest this when I have been on Continuous for over a year now and recently had progesterone upped to 2 a day??

I'm at the end of my tether.

There is also Femoston Conti, which is the continuous version and you shouldn’t get a bleed on that one. Femoston 1/10 is the sequential one, so yes you’d get a withdrawal bleed every month.

Yes, she seemed determined to put me on the sequential version...

See a doctor

They're rubbish with this stuff. We have a menopause nurse who suggested the spray. When I reported I was reacting the GP bumped me to pharmacist. It's like no one there reads the whole story. The nurse was very anti the tablets. Anyway, likelihood is allergies are now systemic and I'll react to everything...

It does sound like someone prescribing based on the standard advice ("oral is generally safer") and not taking the whole situation into consideration (but that's no good because this patient is allergic)! Similarly as I understand it one of the downsides of continuous HRT is that it can lead to irregular bleeding, so it's possible thinks sequential will address this. But obviously that doesn't work if you're getting unmanageable ovarian pain. Would a mirena coil be an option? It has completely stopped my periods.

I'm fine with the Utrogestan so can't see the point of the coil. It's the other stuff that causes the allergies and this, everyone accepts, will not be addressed by the coil. Since upping Utrogestan to two a day I have had very slight bleeding so hopefully that's on its way out. The biggest issue is the fact that I can't take anything transdermally.

Faced with incompetent nurses, doctors and pharmacist I used Newson Health who are specialists in menopause etc.
I had to pay but they sorted my issues and now my GP prescribes what they suggested.

I haven't really got time. My patches run out soon and I need it sorted. Also not too convinced by them after the expose on TV recently.

And also not sure if they'd have any additional pearls of wisdom on the allergies.

Well, speak as you find, they sorted my issues in a week after my consultation.
I went to them after they sorted the issues of a friend of mine. If I believed every expose on the TV I’d be four stone heavier too,
I used to work for a Pharma company and introduced the first continuous combined HRT in the UK.
Perhaps get a referral to a local gynaecologist?

I have actually been referred to gynaecology. They seem uninterested in HRT on the whole and perform scans, promote the coil, and ponder endo every so often.

This is sequential, so liable to lead to monthly bleeds with the ovarian pain associated with this. Why on earth would she suggest this when I have been on Continuous for over a year now and recently had progesterone upped to 2 a day??

You don't ovulate on sequential HRT.
It has no effect on your ovaries.
If your withdrawal bleeds are painful that's your uterus contracting.

After a failed attempt with Lenzetto the pharmacist has suggested Femoston 1/10.

I don't understand- did your GP ask the pharmacist to prescribe?
Not all pharmacists are up to speed on HRT or your personal history.

Unless you are over 60 (which you aren't presumably) pills are fine.
You can have Femoston continuous.

The pharmacist is based at the GP. We quite often have to speak to them about medication tweaks or changes.

The general belief is that my bleeds have been 'natural' - is not withdrawal bleeds. But it's genuinely hard to know.

I went to the HRT nurse very recently to ask to be put on pills continuously and she said 'no, try Lenzetto'. I then reported the allergy to that hence the pharmacist putting me on the pills but the sequential ones. I'm not sure whay she is so insistent on that.

Could the reason be because continuous hrt is not recommended for women who are still having natural bleeds? ( as you said that was the general belief regarding yours). It is generally only recommended for those who have not had a natural bleeds for 12 months?

That’s correct, also breakthrough bleeds are not uncommon in the first few months.

Yes, I reckon so , but I've been on continuous for over a year now as recommended by the GP!

But how would you know what is a natural bleed and what is hormone induced on sequential?

I don’t know- the OP said that the “general belief” was that she was having natural bleeds and not withdrawal bleeds so I was just replying to that.

Maybe the pharmacist has made a genuine error and you just need to ask to change to Femoston continuous.

I have asked but she was quite insistent!

I don't get this.

If you say "I've been on continuous for X years and that 's what I use"

How does the pharmacist say "Well, I'm giving you this now".

Because you'd say "Can you explain why please?"

I had a conversation with her on the phone. It was brief. I had to explain my allergies all over again. She then started reading a long list of alternatives (but said most of them were for post menopausal women. At that point, I did say that wasn't clear). She then said the list was too long to read at the time and she would read it and get back to me later. I was then sent a text message suggesting the Femoston 1/10. I replied to that text saying I should be on continuous for consistency with what other HCPs have prescribed. Not had any response to this.

I don't really understand what the problem is with continuous HRT . Does it increase a cancer risk or something?

Update - there seems to have been some sort of crossed wires and now all the focus is on the bleeding (I mean, I'm not surprised I am having breakthrough bleeds given all the constant changes to my HRT) and the GP has said go to progesterone only and have referred me for a scan. This will be my 4th scan . I feel like I am in Dante's Circles of Hell...

Within the last six months I have had a hysteroscopy and biopsy and all clear and another normal scan.

You need a proper face to face consultation with your GP and get to the bottom of all of this.

Within the last six months I have had a hysteroscopy and biopsy and all clear and another normal scan.

The BMS says there is no need for another scan within 6 months if all was ok. Their advice is to adjust the HRT (but that doesn't mean using just progesterone.)

The basic guidance is this-

• to use combined continuous you need to be period-free for 12 months at least. (That doesn't include withdrawal bleeds.)

• OR over age 54 by which time 80% of women are post menopause

• OR on sequential for 1 to 2 years and then a trial of combined continuous can start but this is more effective for women over age 50.

If you start continuous too soon, it won't control your cycle, so you get bleeding that needs investigating and this is often a waste of time, resources etc.

I don't understand why you've been put onto progesterone only now.
This is not a recognised way of dealing with whatever is going on.

I think you need to consider seeing a different dr.