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[Butterfly16]

Hello Ladies,

I wanted to see if anyone had any experience of switching from continuous to sequential HRT? I'm 40 and was diagnosed with POI at 35, started HRT 18 months ago (2x gel and 1x 100mg every night as it had been 2 years since my last period). The first 6 months I had a bleed approximately every 3 weeks, but this settled and I had 7 months with nothing at all.  In May, I began feeling like I had PMT symptoms - tender breasts, restless legs, bloated, tearful/irritable etc. A week later, I started bleeding, it was fairly light and lasted for 5 days, felt like a 'period'. Interestingly, the day before I started, my mood was really low and as soon as I started the bleed, it felt like a weight had been lifted and much calmer/happier!

I spoke to the private menopause specialist who had originally prescribed my HRT. She wasn't worried about the bleeding due to me experiencing the PMT symptoms and suggested it could have been my ovaries waking up and my own hormones kicking in (apparently in POI this can happen every now and again) and told me to monitor it. Well every month since, I've had PMT for about a week..and last month I had another period. I knew I was going to, as once again I had all the tell-tale signs. Once again, it wasn't just spotting or random bleeding, but followed the exact pattern that my periods used to.

My question is, do you think it would be worth me switching to 2x gel and 200mg for 2 weeks to on a sequential regime? I just feel if I'm still getting some sort of low level ovarian function and this is going to happen would I be best just to switch to this so I know where I am. I seem to have been okay on the continuous utrogestan mood wise, but have sometimes felt a bit flat.  I don't know how I'd be taking 200mg. I know taking it continuously is meant to stop any fluctuations, but that doesn't seem to be happening. It sounds strange, but for the last few months there has been at least a week where I've felt like I've had a bit more oomph, not sure if this is to do with fluctuating hormone levels, but don't understand enough to know which hormones or why! Had enough of it all now to be honest 

Any help greatly appreciated 
xx

[Sage 🍃]

Hi Butterfly16, I don't have personal experience with HRT but that's what's the leaflet says:

"The recommended dose is 200 mg daily at bedtime, for twelve days in the last half of each therapeutic cycle (beginning on Day 15 of the cycle and ending on Day 26)."

If your ovaries are reporting for duty again, I think it's okay to change to a sequential regime.

Good luck!

[shrosphirelass]

Some of the women on here who are post menopausal continue to use a sequi regime because they either don't get on with progesterone or have problems with bleeding when on continuous. In view of that I would say its perfectly ok. I continued on sequi until age 58 and I was not pressurised to change.  I have always used evorel first sequi and now conti so I can't advise about the amount you need to take but I think Hurdity uses utrogestan on a sequi basis. Hopefully someone will give you some specific advice.

[Butterfly16]

Thank you both for your replies Sage and Shrosphire Lass, that's really helpful

I definitely feel it would be worth me trying the sequi regime, especially as I've never taking just estrogen on it's own before, so who knows I may find I feel better. And if my hormones feel all over the place anyway, I don't think the continuous regime is keeping things as steady as they could be. Just unsure about when to start and how!
xx

[Sage 🍃]

Hi sweetie, can you ask your GP or do you intend to keep seeing the private menopause specialist?

[Butterfly16]

Hi Sage, my GP wouldn’t prescribe me the gel without a letter from the private specialist so he doesn’t really have a clue about HRT unfortunately, so I will need to probably pay for another follow up appointment  But I will ask how I can make the transition to sequential and hopefully go from there  :)xx

[Sage 🍃]

Hi sweetie, thank you. That's a shame! If GPs don't have a clue about HRT they should refer their menopause patients to a Gynaecologist on the NHS instead of expecting a letter from a private specialist. Surely Gynaecologists are supposed to have a clue about it? Or is their training limited to young women wanting (or not) babies?! Are they clued up on contraceptives? Because HRT is made of the same drugs in lower doses, basically, so what's their excuse?!
Something is not right! 😣

Good luck to you! 😘

[Joaniepat]

Disagree that gynaecologists would necessarily know much unless they have an interest in menopause. A menopause specialist would be better, and this might be a GP with a Special Interest in menopause and have training from the BMS 🙂.
JP x

[Sage 🍃]

Disagree that gynaecologists would necessarily know much unless they have an interest in menopause. A menopause specialist would be better, and this might be a GP with a Special Interest in menopause and have training from the BMS 🙂.
JP x

Hi Joaniepat, thank you for your input. So all present and future women going through the menopause have to rely on GP's free will to have a Special Interest in menopause in order to get basic treatment? What if there are not so many GPs interested in menopause? Gynaecologists are specialists in women's health, they're not supposed to be just Obstetrics, they have specialised training on menopause and female hormones as part of their core and subspecialty curricula and advanced modules. The BMS is a private charity, I'm talking about the NHS.

[shrosphirelass]

I've had excellent treatment from an NHS regional menopause clinic, having been referred by my GP. However, when I experienced bleeding I was referred to a local gynaecology department. The doctor's focus was on structural issues and they didn't seem to have much interest in HRT or the menopause in general.

[Sage 🍃]

I don't want to hijack the thread, maybe we could start a new one.

I know the situation is far from ideal, I think regional menopause clinics are wonderful for patients who can afford to travel back and forth but not every woman can do that. I'm one of them.

If I have to rely on my GP to get interested in menopause and have training from the BMS, I might end up with osteoporosis or have to pay for a private specialist, which I simply can't do.

I think it would be more rational  if GPs who can't or don't want to deal with menopausal patients could refer them to local Gynaecologists instead of Menopause Clinics miles away from their home.

[Joaniepat]

Sage, Diane Danzebrink runs a campaign called Make Menopause Matter which, amongst other things, calls for compulsory training in menopause for all GPs. (Menopause will affect half the population, after all!) You can sign the petition if you Google for the campaign. She has already succeeded in getting meno on the school curriculum. Apols if you already know about it, but worth a mention in case others see this.
JP x

[Sage 🍃]

Thank you, Joaniepat! Yes I know her work, but what I'm saying is GPs on the NHS should know how to treat menopause issues, but the more complex cases should be referred to NHS Gynaecologists instead of private specialists. GPs can't be clued up on complex menopause issues, unless they decide to be specialists. Menopause is not a simple condition, it involves a lot of different symptoms that overlap with other health conditions and ageing. I really don't think all GPs will be able to be up to date with such a complex condition.