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[Sarai]

Argh I am going insane here.
I'm on Evorel conti 50 and happy except I get a tiny few dots of old blood about once a month, though non at all on half a patch.
So basically I asked if I could swap to sequi so it's planned, but the GP says his guidelines say only in peri or in the year after. But I'm over 2 years post and been on conti a year.
I feel in my body it's created a cycle with getting hotter, anxious, headaches, discharge then a few dots, even constipation.
I don't care about the dots frankly but my anxiety goes sky high each time.
I can't find literature to say I could go on sequi at this stage.
I know I could try gel and prog pessaries but I like patches.
Any advice from our lovely admins, please.

[Hurdity]

Hi Sarai

Been away for a couple of days and your post got missed - just to say that the admins don't actually give advice usually. Dr Currie occasionally intervenes but only very occasionally, and the main Admin - Emma - doesn't get involved in the day to day posts on the forum but will moderate and also put up new posts about menopause etc or info about the forum. The advice is peer-to-peer - and falls to members like you and me to help each other where we can!!! We do our best!!!

Anyhoo - re your question. There is nothing in any guidelines that I know that states that sequential HRT can only be given to peri-menopausal women or the year following menopause. Rather it is the converse (sort-of) ie it is possible to start conti HRT once you have reached this point ie a year after menopause, also if you have started HRT before menopause - at age 54 as a trial. Some authorities suggest trying conti HRT one year after starting sequi HRT whatever stage you are at when you start - but to go back to sequi if bleeding is erratic.

Many gynaes also suggest that if bleeding continues on a conti HRT after 6 months has elapsed (and investigations show nothing is amiss) you can either change the dose/type of HRT to increase the dose of progestogen (relative to oestrogen) or if progesterone intolerant, revert to a cycle to minimise exposure to the progestogen.

Conti HRT won't of itself create a cycle where there isn't one. I really can't remember whether you were 12 months without a period ( and no Mirena or mini pill) before starting HRT but I did think so? Some of your symptoms could be due to the progestogen (norethisterone) which will be exacerbated when on a whole patch because you are taking the progestogen all the time. Some women find this can sometimes negate the positive effects of the oestrogen!

You could ask to be referred to a menopause clinic or write to Dr Currie explaining your predicament - although she is very much in favour of no-bleed regimes as they lessen the risk of endometrial hyperplasia once you've got the dose right to no-bleed.

Have you thought of a Mirena coil and then you could add the 50 mcg patch which deals with your symptoms - and help build your bone - I think that's your reason for being on HRT?

I like patches too!

Hope this helps

Hurdity x