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[TwoCakes]

Hi all,
I'm 48 and started HRT Oct 2016 after several years of peri-menopause symptoms and then full on hot flushes, memory probs, infections, flat mood etc!
My GP prescribed Evorel Sequi patches which appears to be standard practice and means a 'monthly' bleed. It has suited me very well indeed with ALL meno symptoms gone and no negative side effects after the first few months.
Quite frankly I could do without the monthly bleed and the period pain and exhaustion that comes with it (though very short lived). Upon renewing my prescription I asked the GP if I could change from Sequi to continuous Conti. She wasn't sure and said she would check - I suggested we revisit it when I go back for the next prescription in Sep 2018.
So my question is: Can continuous Conti be prescribed for someone at my age who did not have 12 months period free prior to commencing HRT? If so is there any good quality medical guidance that I can use to support my GP to make that decision?
Might also be worth mentioning that my GP suggested cutting down the patch or considering stopping. I did slowly cut the patches down but as soon as it got to a 3/4 patch the hot flushes returned so we aint going there! Oh yes and I did have blood tests prior to the HRT starting and was 'well within the menopausal range'.

[Dancinggirl]

Hi and welcome to MM

You would need to be at least 12 months without a natural period before switching to conti HRT patches or pills - this might involve coming off HRT for a few weeks to have a blood test done to see where you are in your menopause journey - especially as you are under 54.
 What might be a really good option for you would be to have the Mirena fitted. The Mirena delivers a low dose of continuous progesterone more directly to the uterus and this will usually result in no bleeding at all after the first few months. You could then have oestrogen only patches alongside.  The Mirena works really well in both peri and post menopause to control bleeding and cramps etc. I had one for 4 years and found it very good in comparison to oral or other transdermal progesterones.
Here is the info on the Mirena:
MIRENA
Mirena is a levonorgestrel (type of progestogen) releasing system which sits inside the womb, gradually releasing the progestogen into the womb. It is licensed in the UK and Ireland as a contraceptive agent, for treatment of heavy periods and, from August 2004, also for the progestogen component of HRT. It can be used in both the perimenopause and postmenopause and it is particularly useful for:

Persistent progestogenic side effects from systemic HRT despite changes in type and route of progestogen.
When contraception is required along with HRT in the perimenopause.
When withdrawal bleeds on sequential HRT are heavy, after investigation if indicated. (see WHEN TO BE REFERRED )
With Mirena in place, systemic estrogen alone can be taken as the Mirena provides adequate protection of the womb lining and the estrogen dose and route can be tailored to meet the individual's needs.

Progestogenic absorption throughout the body is minimal so reducing progestogenic side effects. The effect of Mirena on the womb lining can significantly reduce bleeding and when used as part of an HRT regimen, in time, 30 to 60% of women have no bleeding at all. Although Mirena used for contraception is licensed for 5 years, the license for use for the progestogen part of HRT is currently 4 years.
Price: £88.00



DG x

[TwoCakes]

Ooh, thanks so much Dancing Girl. I've been wondering about Mirena - I think it might be a really good option for me, having read the info you've supplied. I am a bit of a wimp...is it painful to have it fitted?

[Dancinggirl]

It can be uncomfortable but it's quick to fit - if you take some painkillers beforehand that can help. They use some local anaesthetic when it's fitted and there can be some cramping for a few Horus afterwards.  If you've had children then it can be easier to fit as well. IF you want a no hassle HRT regime then the Mirena with an oestrogen patch would be your best option at this stage. 
I'd print off the info to show your GP to aid discussion. You may need to go to a Family Planning or menopause clinic to have it fitted if they don't do it at the practise. DG x

[Hurdity]

Hi TwoCakes

 

As Dancinggirl says and also - why on earth did the doc suggest your cutting down on oestrogen? You're not even at the natural average age of menopause yet (51/52) so taking a medium dose of oestrogen is recommended anyway - for protection of heart and bones.

Some docs will transfer a woman to conti HRT after a year of sequi - as a trial but if problematic bleeding continues then reverting to sequi is recommended. It also depends how far towards menopause you were when you started HRT - ie if your periods were few and far between and very sporadic then a change to conti HRT might work. It also depends on the preparation as some progestogens are more effective in thinning the womb lining than others - at lower doses. Most women who have been on cyclical HRT for a while will be transferred to conti HRT at 54 when according to some stats 80% of women will have reached menopause.

Hurdity x