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[owenlana]

Have been on evorel sequi for 10 years, started at 41 early menopause and have been on sequi ever since.  Now I am 51 doc has suggested I switch to continuous hrt
Haven't yet had appointment just a quick chat on phone with doc.  I have no idea what to expect. 
Can you take continous in patch form?  What are the pros in moving from sequi to continuous and downsides??
I have no idea what this change may entail.  Is it advised to take this form of hrt for many years?
Anyone experiences on continuous hrt would be really appreciated to give me an idea what I may expect.

[Wrensong]

Hi Owenlana,

Your doctor has probably suggested moving to a conti form because at 51 you are at the average age for menopause proper i.e. final period.  Conti is usually prescribed to women postmenopause as taking both oestrogen & a form of progesterone every day should in theory result in your being bleed-free.  I say in theory, as during the first 6 months it is fairly common to have breakthrough bleeding, though this is nothing to worry about. 

A few women, however, don't settle on conti & continue to bleed on & off after the initial 6 months, in which case we are usually scanned to check all is OK & sometimes a hysteroscopy is carried out, during which the uterine lining is sampled.  Quite a few of us on here have been in that situation.  Me included.

The BMS web site is currently showing Evorel Conti as out of stock until June, so how easy it will be for you to get a script filled at present I don't know, but hopefully it will be back in stock by the time you need it if you decide to go with your GP's recommendation. 

If you have always felt well on the progestogen phase of your Evorel Sequi regimen, hopefully you will not feel any detrimental effects for the change to taking it every day.  The big plus is that you should then be bleed-free for the future.

Many of us on here continue with a sequi regimen into later years (some of us into our 60s) & put up with a bleed because we feel unwell on the various forms of progesterone.  Some of us also wish to minimise our exposure to progestogens as they are considered to slightly increase risk of breast disease.

I believe current guidelines state that we can continue on HRT for as long we need for symptom control, providing there is no medical contraindication.

I'd say you have little to lose by trying a conti regimen, but if you are perfectly happy on sequi you could ask to continue with it, or alternatively taper off to see how you are without HRT if you prefer not to continue indefinitely.  If you are considering tapering off, might I suggest that you may want to do this at a time when there is not too much stress in your life, as the body often takes a while to adapt & meanwhile you may find you have unpleasant withdrawal symptoms.

I hope that helps.

[owenlana]

Hi Wrensong,

Thankyou kindly for your message, thanks for covering everything.  That has helped me a lot as I have no idea what it all entails.

Yes I have problems getting my evorel sequi just now.  I purchased from ind pharmacy online but they too have run out.  I have about 6 wks left so hopefully will be back in stock by then

I do find the evorel conti wks not so good as the evorel 50. my mood is not so good on this part.  Perhaps  for this reason I will need to stay on the sequi! Bit worried however having been on it now for over 10 years, not sure if this is something that should be of more concern.

Hmm I understand when you mention stress etc.  and coming off completely, I tried cutting patches due to the shortage but just found my mood was not right. 

Thankyou for your indepth explanation, it has helped me.   Is it a patch on the continous regime that provides both oestrogen and progestogen? 

[shrosphirelass]

I was on evorel sequi for 18 months. I'm now 58 and probably menopausal (was still having periods when I started on HRT).

I opted to change to evorel conti as I get severe headaches which in the past were related to my periods so I wanted to see if having a more stability would help.

Two months later my headaches are much improved. Ive had physio and worked on my posture which may have helped and am taking steroid nasal spray to reduce nasal congestion, so its hard to say for sure what has helped.

I have experienced quite a bit of bleeding which I wasn't really expecting as I had been doing ok on the sequi regime. I'm hoping this is just the change over and that it will settle.

I got my prescription last week so there may be some supplies in local chemists.

Let us know how you get on.

[sheila99]

51 may be the average age for meno but you may not be average, there are several women on here still cycling in their mid 50s and beyond. You should be on sequi until you're meno but presumably you don't know where you are? It used to be that they thought you shouldn't take it for more than 10 years or after 60 but not anymore. I get tired on my prog (Utrogestan) so I intend to stay on sequi when I'm meno, if you feel worse on the conti patches I would stay on sequi. I believe the conti you would be on are the same as the conti patches you use atm?

[Hurdity]

Hi Owenlana
 
You've already had great advice from the others. This is just to say that I am one whom Wrensong (hello Wrensong!) refers to as being in 60's and still taking the progesterone part of my HRT cyclically. There is no way I would want to take it all the time as I would feel even more tired than I usually am and definitely wouldn't want the persistent head fog not to mention the potential increased risk of breast problems.

In your case it would just mean you are taking the Evorel conti patches ( that you are currently taking for two weeks) all the time. No different formulation so you would be getting that amount of progestogen ( the norethisterone) every day. If you feel rough on this part of the combo then probably best to stay on sequi. You are so young after all! Many of us did not start HRT until older eg I started at just under 54 and I am still taking it in mid 60's, still cyclically ( though not happy with that at my age).

If you are happy still having periods then why not continue for a few more years yet?

There is apparently a slight increased risk of endometrial cancer with cyclical vs continuous HRT but like Wrensong said continuous HRT with synthetic progestogens may be associated with an increased risk of breast cancer so it's a toss up really. I would go with your gut feeling and at your age, why rock the boat?

Hurdity x

[owenlana]

Hi Hurdity and others
Thankyou for your replies, sorry to hear it makes you tired all the time on the conti, this is troubling.  I dont have time to feel tired all the time!  or head fog.  not good.

Hurdity you say would be same patch the evorel conti part worn all the time, and the evorel 50 oestrogen part, wearing for 2 weeks?  so would be wearing 2 patch at a time for 2 of the weeks?  is that right? 

Also you say you are taking still cyclically and your not happy at your age, sorry to hear that, is there another alternative for you?  Just trying to figure out what my own future on this hrt could entail. 

Why is it that with a monthly bleed on the sequi there is more chance of endometrial cancer, I thought the bleed was a good thing and prevented any build up of any problematic cells.  This is not the case?

Thankyou for your infos I have some thinking to do about this.  Part of me would like to come off this completely after been on for so long, but not convinced this would be a good idea either.

[TwoCakes]

Hi Owenlana,
I went onto Evorel Sequi at 48 and it suited me very well apart from a 24 hour period at the start of the monthly bleed when I was absolutely exhausted. Switched to Conti at 50 and apart from very minor breakthrough bleeds at beginning it's been great. No negatives at all until the supply problems which mean I now have no patches and hot flushes are back!
Only thing I wish I'd checked when transferring over was when is best to change over from Sequi to Conti e.g. straight after monthly or whatever.
Oh and the patches are dead simple. One patch for 3-4 days, take off and pop new one on for the same.

[Hurdity]

Hi owenlana

Each woman is different and also different progestogens have different effects. Progesterone itself has to be taken in very large doses in order for sufficient to get to the uterus because it isunstable in the body. Therefore the sedative effect can be more pronounced.

Some women like this but I am well post-meno in my 70's and my body has changed to make me more tired in the mornings and sleeping more deeply so I don't need any more sedation . I haven't tried taking it continuously but I've definitely had more than enough by the time I get to 12 days (but at least I am on a longer cycle of approx 6 weeks (varies somewhat). which lessens the frequency I have to take it.

The progestogen in Evorel sequi is different - maybe less sedative but can be associated with other pms type side effects although you can see that many are perfectly happy with it like TwoCakes!

No you wouldn't be wearing two patches if you changed to conti. You already have the Evorel conti patch in your second two weeks of Evorel sequi. The conti patch contains both the oestrogen and the progestogen so it would be as now - just one patch at a time and with conti the same one.

I probably didn't make myself clear enough. I am happy on HRT but of course having a bleed at my age is no fun! If I was really unhappy I would have done something else or come off HRT. I like having more than 4 weeks on oestrogen alone!!

Re cancer risk: the absolute risk is very low. Here is the summary info on this site: https://www.menopausematters.co.uk/risks.php

"Endometrial Cancer

    Estrogen only therapy given to women with an intact uterus increases the risk of endometrial hyperplasia (thickening of the lining of the uterus) and eventually endometrial cancer. Daily estrogen combined with progestogen given for 10 to 14 days per month (sequential HRT) reduces this risk but does not eliminate it. Sequential HRT given for more than 5 years does increase the risk of endometrial cancer by a small amount but no increased risk appears to apply to estrogen combined with daily progestogen (continuous combined or period-free HRT)."

Provided you take the licensed amount of progestogen the increased risk will surely be minimal especially on low to medium doses of oestrogen. Also being overweight (ie with fat) is a much greater risk factor for cancers generally, so making sure you have healthy BMI not in overwight range cutting down alcohol and taking plenty of exercise etc, you are doing the best you can for your health. As alaways any abnormal bleeding should be investigated. Usually referrals are made at a very early stage if reported promptly to the doctor so often cancers can be caught very early anyway, or well before they reach that stage ( ie thickened womb lining).

If you don't have head fog now on the Eovrel sequi then probably you won't when using it continuously?

Hope this helps and let us know what you decide!

Hurdity x

[Wrensong]

Hi again Owenlana, sorry to be late responding but I see the other ladies have as usual given brilliant advice, covering your additional questions.  Just to say I hope you get on well with whatever you decide to do & do let us know how you are.