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[menomummy]

I am currently taking the equivalent of Evorel Sequi patches, that is two weeks of Evorel 50 then two weeks of Evorel Conti.   

I am wondering how will I know when it is time to change to Evorel 50 only patches, so estrogen only, not progesterone?

The advice on this site says:
" 1)Patient known to be post-menopausal at whatever age, ideally by having at least one year of amenorrhoea (no periods).
2)If sequential therapy started while still having periods, wait till age 54 years. At 54 years 80% of women will have cessation of ovarian function and are likely to settle on continuous combined (period-free) therapy.
3)Change from sequential to continuous combined by finishing current sequential pack and start new therapy at the end of the expected bleed."

So do folks here just switch at 54 years whether or not there is any suggestion of natural cycle still trying to rule!   My natural cycle and my patch cycle are in and out of sync with each other still, just wondering if it becomes obvious that the bleed is patch induced eventually?

Thanks


 

 

[Dancinggirl]

Hi and welcome to MM menomummy

When you say your natural cycle is out of sync with the HRT regime cycle what do you mean?  Are you getting erratic bleeding or do you get a regular monthly bleed after finishing the progesterone+oestrogen phase of the HRT patches?
If your bleeding is erratic then you may need a scan to see if your womb lining has built up too much. It may be necessary to try a different HRT type.  If you still have a womb/uterus, then you will always need progesterone to prevent the womb lining from building up due to the oestrogen - whether on a sequential or continuous HRT regime.
Sometimes with patches there can be an issue with absorption and this can lead to erratic bleeds.  You haven't told us when you started HRT(so how long have you been on HRT) and what was going on with your periods when you did start the patches?

Rushing to move to a continuous HRT regime is not always the best idea - a lot depends on how you feel when on the progesterone phase of a particular HRT type.  A Conti HRt regime uses progesterone every day(as well as oestrogen) and not all women do well on this as progesterone can bring more side effects.    If you are still peri menopausal (and this is difficult to know unless you stop HRT for 2-3 months and then have a blood test) then switching to conti HRT may cause more erratic bleeding.

If you are keen to be on a bleed free HRT regime then I would suggest you consider a Mirena and use oestrogen alongside as either gel or patch. Once the Mirena is fitted, then during the first few weeks the bleeding usually reduces and often stops, so this can be a good, no hassle, HRT option.  The Mirena is often recommended by gynaes for any women who experiences problematic bleeding anyway and it can be used in peri and post menopause.

Here is the info from this site about 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 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. However national guidelines recommend that it can be used for up to 5 years for the progestogen part of HRT.
Price: £88.00

DG x

[Cassie]

I may be wrong but I do not think that there is any medical indication why you should have to change if the cyclical is suiting you?
Surely if you have a uterus you will always need progesterone, to protect it, but by taking continuous progesterone, you can avoid a bleed.

[sheila99]

My cycle was forever out of sync when I was on patches because my natural cycle is longer than 28 days. I had to change to gel because of a rash and have found it much better now I can change the hrt to work with my body instead of against it. I can tell when my body is contributing, can you? I don't think you can rely on age. I'm 58 and still peri.