When did you move on to continuous HRT?

[MrsSmorrebrod]

Ever so slightly embarassed not to have understood how my own body works... but here goes: I'm curious about when you switched from sequential to continuous hrt? I'm 51 and have been on evorel sequi for a couple of years. Just had a review where my GP asked if I still have periods to which I replied yes because I do... or so I thought. I have now been reading about this and realise that what I'm having is probably 'just' withdrawal bleeds, and for all I know my natural periods may have stopped but how do I know... like an idiot I've been waiting for the damn things to stop by themselves. So, having now realised that, from what I can read, it seems that around 51/52 most GPs will make the assumption that it is now safe to shift to continuous and be rid of periods altogether. For my recent review there was a suggestion to stop taking HRT altogether to see but I rejected that because I'm concerned my mental health will return to where it was before I started taking HRT to begin with. I'm supposed to go back for another review after I have taken my current evorel 50/prosgesterone regime for 3 months. Anyway, what do you know?

I'm 42 but my gp was talking about moving me onto continuous hrt at my review next year. I'm still having fairly regular periods though so I'm not sure if that will work out. And mine are definitely periods, I've never had a withdrawal bleed.

I think the guidelines are, if over 50, you can switch if periods have stopped or after one year of sequential treatment so you could ask to try it at your next review

Thank you both, but how do you tell the difference between a withdrawal bleed and a period? So for the last two years I've been taking evorel sequi and I would bleed when I finished a pack and then start another pack.

oh sorry, just spotted the 'or after a year of sequential' bit. I did tell her I'd been on sequi for two years, but maybe now that I know I'll just remind her when I next see her

It's unlikely your periods will be regular, so that's how you may be able to tell they are periods and not withdrawal bleeds.

But the only real way is to go 12 months with no HRT.

The guidance (it's on Menopause Matters website under HRT) is continuous combined is for women over 54 or younger women with no natural period for 12 months.

You can try continuous but if you are not post meno the amount of progesterone won't control your own cycle and you may bleed at odd times.

It's not always the right thing to swap to continuous as you may get symptoms from daily progesterone.

You can actually make a choice.

I've been on sequential for over 15 years and prefer it for those reasons.
I know someone over 70 still on sequential.

I'm on continuous HRT and I get a bleed every month for about 3 days.

crikey this is really complicated stuff... so do you - and your friend who is 70 - still get periods? I'd like rid of the hormonal fluctuations, but seeing as I already struggle with the progesterone end of my cycle, now I don't quite know what to think

And how does it work with hormonal fluctuations? Do you still get PMS style symptoms on continuous?

No, just a bit of constipation when I switch to the green pills (progestogen) but not always.

What would the GP do in my case? I'm approaching 50yrs as on the COC. I run my packs together so never have a withdrawal bleed.

Aah, see this is what I'm after... I never had many physical symptoms of menopause, it's always been cognitive and emotional, so that's what I was hoping to flatten out (so I might stop spending the last 4 days of every cycle thinking that everyone is going to die in a traffic accident!)

I am 53 on sequential for two and a half years. I bleed all over the place, sometimes before I finish the utrogestan, or just after, or several days after or not at all for six months! No idea where I am or what this means. I’m 54 in six months so may just swap to continuous. No issues with the utrogestan.

See, I previously enquired on this board about the difference between periods and "bleeds" on sequential HRT, and was told that you nearly always have a progesterone withdrawal bleed so it's difficult to tell.

I must be an outlier then because I'm still on sequential and haven't had any kind of bleed for 4 months....

What is sequential? I'm on Evorel 50. GP just put me on it at 48! No tests. Nothing. I'm definitely peri now but at the time because of Mirena I couldn't have told him when my last period was. I don't understand all this!

Im 57 and have been on continuous gel/patches plus a mirena for about 5 years. I couldn’t see the point of having withdrawal bleeds that you get with sequential HRT.
I definitely get cyclical symptoms, maybe every 6 - 8 weeks - feeling a bit crap and eating my own body weight in carbs for a day, then getting a tiny bit of spotting the next day, so I’m assuming my natural cycle is still rumbling away in the background. But thinking about it, the last spotting was longer than a couple of months ago.

I don’t know either when I can consider myself to be properly in menopause. But they say taking HRT post menopause is beneficial so I’ll carry on with it for now.

I’m 42 and the last time I was at the gp she suggested that I should go on continuous patches even though I still have regular periods (and I think they are periods not withdrawal as my cycle is not regular to the patches). I’ve been on evorel sequi for 2 years now.
i am starting to struggle with the fluctuation particularly progesterone and have also been previously offered a mirena coil which at the tine I refused but now am considering as my mood changes a lot during my cycle)

I started sequential at about 50 I think. I moved onto continuous in Februay this year at the age of 66. Purely because I was sick of having periods that seemed to be getting heavier. I was OK on the continuous until end of April, when the bleeding started. And boy, did it start!! 4 weeks of being so heavy I couldn't leave the house. I was warned there'd be spotting but this was not spotting. I went cold turkey and stopped it completely at the end of May. GP sent me for hysteroscopy and ultrasound which showed my womb lining had thickened.

I'd like to try again, as I'm at risk of osteoporosis. But GP isn't keen.

I have just moved from Femoston 1/10 to Femoston conti ultra low. I am 15 days in and the jury is out whether working for me. Having a light bleed (day 14 and 15 so far) and much more aches than usual in legs in particular. Had some twitching in thigh and weirdly in bottom lip. Hope all just a result of lowering dose and will settle.
I was on Femoston 1/10 from 55 til 58. Had review. Now in early days of conti...

They are withdrawal bleeds, yes.
Better than to put up with than the effects of daily Utrogestan.

@thenightsky Ask to see a specialist- you can certainly go back on it if you want to.

If doesn't settle will go back to gp. I was happy on Femoston 1/10 but he suggested bit old for it hence conti. My next move will be transdermal I imagine.

There's so much misinformation on this thread.
GPs are 'told' to switch women to continuous asap because of the slight risk of hyperplasia on sequential if used long term.
No one mentions the fact that breast cancer risks are higher with continuous (about 1% according to the research.)

That's a point which ought to be discussed so you have the choice and keep in mind your baseline risk.

I don't know enough to know what's misinformation, but its really striking from reading this how inconsistent the messaging from GPs seems to be, how much trial and error people have to go through, and how differently people seem to respond to different types of hrt... I'll definitely take myself over to the Menopause Matters website you mentioned!

I’m on continuous. What are the effects of daily progesterone?